Is Limb Lengthening Surgery Worth It to Fix a Leg Length Discrepancy?

What is a Limb Length Discrepancy and what causes it?

It’s basically when a person has unequal leg lengths either due to trauma that to their growth plates, such as in my case - being a young and dumb kid - or it could be due to a congenital condition originating from birth. 

Discrepancies are actually pretty common, research showing that around 50% of people have some amount of height difference between their legs. 

Now this height difference can be rather small, where the person may not even notice and it won’t cause any issues later on down the line but sometimes it can be rather large creating big problems for the person such as structural alignment issues that could lead to what I call “the cascading chain of pain” from the ankle, knee, hip, back, and neck among other areas.

So what are some of the symptoms you might experience with an LLD?

Well if the discrepancy is large enough, or you’re involved in intense physical activities such as sports or heavy lifting, then you may ache in the joints and notice tight muscles around your lower back and hips since that's where a lot of your body weight is distributed.

I mean I remember walking around my college campus, which was huge by the way, and I’d try to catch the shuttle whenever I could but of course it would always avoid me, but by the time I got to where I was going, I would have a burning sensation in the lumbar region of my lower back of my taller side as if I had done some sort of high rep set of deadlifts and I'd have to sit through classes all day with this throbbing pain in my back and have to take pain killers to alleviate it and focus on schoolwork.

When I would work out, say for example squatting with weight on my back, I realized I had to place my shorter foot further in front in relation to my other foot, which affected my knees - developing a valgus on my taller right side and a bit of on my shorter left side. And as if these structural alignment issues weren’t enough, it also led to muscle imbalances and symmetry issues as some parts would get more stimulated.

I would also notice shooting nerve pains!

Mostly in my back after doing heavy lifts and intense activity due to compression which can also be frustrating. I’m also sure some of you with discrepancy have experienced things like random headaches and exhaustion out of nowhere even if you thought you slept well right? Yup I’ve been there too.

Remedies

Now that we know what a leg discrepancy is, what causes it and what symptoms you might feel from it...what can we do about it?

Well you really have 3 options but two of them are more reasonable in my opinion. 

        Option 1: Shoe Lifts -

Okay so if you have a discrepancy of ¼” or less, you could opt for a shoe lift insole that you put inside your shoe and you may find relief. But for anything over that, or let’s say a ½” or more, I would suggest a full shoe lift build-up from a professional shoe lift company. And luckily for you, I’ve already interviewed two of the best in the world: Orthopedic Shoe Lift via American Heelers owned by Illya Romanov and the other is Shoe Lift Express by Mariana and her dad. 

I suggest you get your discrepancy properly measured via x-ray by an orthopedic surgeon and then once you know how much it is, you can get that exact amount added to the shoe lift and see how it feels. I know mine was night and day and I absolutely loved it. However with a near 2 inch discrepancy I didn’t want to wear a big shoe lift for the rest of my life and could only imagine when I might want to run barefoot in my 50’s on the beach and not fall down keeled over in pain because of joint or back pain. And so I chose option number two…

        Option 2: Limb Lengthening - after doing some research by bootstrapping some information together on the internet - which is another reason I made this channel - I scheduled a consultation with my surgeon and got measured and within about 2 months I was getting the procedure done on my leg. The process is just as you know it, lengthen, therapy, heal, stand, walk, lift, run, sprint and eventually jump! 

        Option 3: Limb Shortening - this is when the surgeon will actually remove a measured piece of your taller limb and balance your hip height that way. I’m not a fan of leg shortening as I think it could possibly affect your muscle tone which might not be very aesthetic to some patients and it could lead to a possible decrease in some strength due to muscle contraction issues but discuss it with your surgeon to see if it’s right for you. 

Threshold

So time to answer the question of the day - is limb lengthening surgery worth going through to balance a leg length discrepancy? And in my opinion, if you’re over 1.5-2cm I say yes. 

And hear me out. I can’t tell you how annoying it is to stand up each and every day, just feel my hips are tilted, back is curved, neck is crooked, knees are torqued and my muscles imbalanced. 

And that’s just the physical! But something you may not know but discrepancies can affect your psychological too! I mean sometimes I’d get borderline depressed, I felt like I was handicapped. 

This disconnect really made me feel inadequate like I’d never be my best or reach my full potential unless I got it fixed once and for all by doing limb lengthening surgery. 

So again I say at least get it checked out because the long term repercussions could be far worse than a half a year of laying low. 

And if you’re a younger person who is still growing and have a leg length discrepancy, the really cool thing is surgeons can use something called the multiplier method where they can determine how big the discrepancy will be when the you’re fully grown. 

Cosmetic Stature Lengthening Question:

What about stature lengthening patients who plan to lengthen one leg at a time, is this a good idea. Well it’s not ideal but it can make the process more bearable in the short term in terms of mobility for example if you decide to do the procedure without a fully weight bearing internal nail. But the time and cost could be factors that make you want to just get it done bilaterally. Again this is best decided with your surgeon. 

Unequal Knee Heights

And one more thought to consider when doing limb lengthening for a discrepancy, what if all the height difference isn’t perfectly divided into one limb which it often isn’t? Well the relief should still be there and the surgeon will most likely ensure the knee height isn’t excessively different although my knees aren’t perfectly balanced, my left is actually a bit taller than my right and although I don’t notice it when doing low-impact conservative activities like walking and so on. When in a deep squat or two leg press I do and have to take a wider stance or concentrate on proper load distribution so I don’t get unnecessary valgus or varus buckling which I’m starting to suspect is the reason for my more recent knee injury. I suppose I may have limited time left in my sport...and it’s not because of limb lengthening, it’s the long term effect of a discrepancy for a no-holds-barred athlete. 

So as you can see, if large enough, a leg length discrepancy can cause you physical or psychological pain and I suggest you test out your relief with a shoe lift build from those companies I mentioned but if you are overwhelmed by the tedious frustrations that come along with the height imbalance, then do yourself a favor and get seen by a limb lengthening surgeon and they can discuss your options so you can also live a better life.

-C4L