Short-leg syndrome.

Abstract

Short-leg syndrome, or asymmetry of length in the lower extremities, is a common orthopedic problem in children. It is vital to recognize normal bone function, bone growth, and potential growth when evaluating this syndrome. Classification of this problem is either structural or functional. Structural (real) short legs usually have trauma or congenital growth inequality as their etiology. Functional (apparent) short legs usually result from soft tissue contractures or foot function aberrations. The child's age determines the extent of our examination. The lower extremity should be segmented during examination to help determine the location of pathology. Measuring the deformity requires precise scientific procedures. The level of compensation must be determined. Foot, pelvic, and spinal compensations should be evaluated. Scanograms or orthoroentgenograms are useful in diagnosing, quantifying, and prognosing short-leg syndrome. Prediction of the projected discrepancy is accomplished by the Anderson et al. remaining growth charts. Common etiologic considerations include congenital, neuromuscular, infection, trauma-induced, and tumor-caused disorders. Treatment of short-leg syndrome is determined by classification. Structural problems may need heel elevation or a combination of heel elevation and orthotic control on a conservative basis. Functional problems may require neutral position control of the feet with orthotics and correction of soft tissue contractures. Resin foam or orthopedic shoe adjustment may be used in moderate discrepancies. Structural leg inequalities may be corrected by surgical epiphysiodesis. This bone growth retardation procedure is normally performed on the long limb in pediatric patients. Therapy is directed at correcting pelvic obliquity, gait and postural aberration. The end result should be a child with cosmetically acceptable and normal functioning lower extremities.