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Leg Length Difference

Anyone who is suspected to have or aware that they have a leg length difference should be checked.


Significant leg length differences lead to life-long musculoskeletal deformity.


Mild variations do exist between each side of the body as we are not entirely symmetrical in our built. Leg length differences do not usually cause problems if they are small. More extreme cases of leg length differences result from leg fractures, total knee or hip replacements and diseases such as polio or bone cancer.



  • Asymmetry of growth spurts
  • Trauma or fracture of one leg
  • Disease or illness stunted growth
  • Bone conditions / infection (dysplasias)
  • Neurofibromatosis, Multiple hereditary exostoses, Ollier disease
  • Neurological Conditions
  • Inflammatory joint conditions i.e. Arthritis or rheumatoid arthritis

Paediatric Leg Length Difference

Leg length discrepancies become obvious to parents when they notice subtle changes in their child’s walking and an inability to perform well in sports and play. This is normal in children as they go through asymmetrical growth spurts. However, regular checks must be carried out because the main concern with paediatric cases is that when the child grows quickly, they are susceptible to leg length differences and scoliosis (spine curvature). If the leg length difference is not evened out (treated and addressed) this can become detrimental to the child.


A limp or altered walking pattern will prevent the muscles and bones from developing correctly.


Patients with a limb length discrepancy are more likely to experience lower back, hip, knee and foot pain. With a variance in the loading forces on the left and right foot, they are more susceptible to injury.


Leg length differences can be addressed using orthotic insoles lift on the inner side of the shoe and an external lift on the extremities of the shoe in severe cases. This is very technical and allows a maximum correction of 3.5cm within the shoe itself. External correction allows for more room for adjustment, as the foot will not come out of the shoe.


A full gait analysis and biomechanical assessment must be carried out to ensure the degree of correction is accurate and not detrimental. Measurement of a leg length difference may require a full-length x-ray to be taken, this need will be determined during clinical assessment.


A discrepancy in the length of the legs results in one foot taking more weight than the other. This often results in chronic heel, ankle, knee, hip and back pain. The child may also be reported to fall over more, noted to be clumsier than their peers, unable to excel in sporting activities or lack educational concentration as they suffer from chronic pain.


Treatment for a leg discrepancy depends upon the severity that is presented. In many cases, a minor difference in leg length can be evened out by wearing a custom insole in the shoes. However, a child with a more significant difference may benefit from surgical intervention to make his or her legs the same length. This can be done several ways but is most often accomplished through a procedure that slows or stops growth in the longer leg. For such procedures, patients should be referred to trusted lower limb orthopaedic surgeons.



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