Dedicated to Helping Parents

Leg length discrepancy (LLD), or unequal leg lengths, can be challenging for both the child and their family. Treatment options for LLD include conservative, or non-operative options, and also different surgical methods, such as intramedullary lengthening nails. Treatment for severe discrepancies may involve multiple procedures over time and can be a long and demanding process. Emotional and psychological support, along with ongoing physical therapy, plays a critical role in helping children recover and maintain well-being throughout the journey. While your child’s orthopedic care team is essential, parents and caregivers also have a significant role in providing day-to-day support and comfort.¹

In this article, we’ll explore how parents can offer both practical and emotional support during and after the treatment of LLD.

Daily Life Adjustments

Children with leg length discrepancy face unique challenges in their daily lives. A difference in leg length can affect posture, walking patterns, and overall physical activity. Even mild LLD can have a lasting impact if not managed properly.

For children with mild discrepancies, using shoe lifts or orthotic devices may be enough to correct posture and walking. These LLD-corrective footwear solutions can be custom-made or over-the-counter. In some cases, a simple shoe insert will suffice, while more pronounced leg length differences may require custom shoes or orthotics.^3,4 The need for corrective footwear may be temporary, used until the child is ready for surgery, or a permanent solution for children who do not undergo surgery.²

Surgical intervention with intramedullary lengthening nails is commonly used for patients with moderate and severe LLD, but also is an option for patients with smaller LLD that are not candidates for shortening procedures and desire to restore natural limb length and height. This cutting-edge procedure allows controlled, gradual bone lengthening. Daily life adjustments are still necessary post-surgery, but modern surgical techniques can help restore normal function and mobility over time.

Emotional Support for Your Child

Coping with leg lengthening surgery or any form of LLD treatment can be overwhelming for children, making emotional support crucial. As a parent, it’s important to communicate with your child openly, offering age-appropriate explanations about their condition and what to expect during treatment. Children of different ages may psychologically respond to surgery and each child will have unique emotional needs from their family and medical team.

Creating a supportive environment at home is vital. Encouraging your child to express their feelings, involving them in decisions when appropriate, and helping them understand the purpose of the treatment can make a huge difference. Additionally, connecting with other families undergoing LLD treatment and seeking professional psychological support can provide further emotional relief.⁵

In many cases, your orthopedic care team may include a psychologist to help your child navigate their emotions throughout the process. Ensuring your child feels secure and supported will positively impact their treatment and recovery.

Educational Support for Children with LLD

Managing school and education during LLD treatment requires coordination with teachers and school administrators. Whether your child is recovering from limb lengthening surgery or adjusting to wearing orthotic devices, clear communication with the school is essential.

Physicians may offer to support children in returning to school as soon as reasonable after surgery, typically 2-3 weeks. However, some families may prefer to utilize homeschooling options during the post-operative weeks or months until they can return to school without assistive devices or special accommodations.

If returning to school relatively soon after surgery, parents should work closely with teachers to establish a plan that accommodates any mobility limitations or special needs, such as modified physical activities or additional breaks. This is particularly important during the recovery phase after intramedullary lengthening surgery, when mobility might be restricted. Teachers can help your child stay engaged with schoolwork while respecting physical limitations, ensuring they remain active both mentally and socially.¹

Conclusion

The journey through leg length discrepancy correction can be long and challenging, but parents can play a significant role in providing both practical and emotional support. By creating a supportive network that includes family, healthcare providers, and educators, you can help your child thrive throughout the treatment process. From daily life adjustments to emotional encouragement, your involvement is key to their success.

References

1. Hartley J. Chapter 13 – Orthopaedic conditions. In: Pountney T, ed. Physiotherapy for Children. Butterworth-Heinemann; 2007:199-218.
2. Tyrrell W, Carter G. CHAPTER 8 – Prescription footwear. In: Tyrrell W, Carter G, eds. Therapeutic Footwear. Churchill Livingstone; 2009:114-123.
3. Wynes J, Schupp A. Assessment of Pediatric Limb Length Inequality. Clinics in Podiatric Medicine and Surgery. 2022/01/01/ 2022;39(1):113-127. doi:https://doi.org/10.1016/j.cpm.2021.09.004
4. Kendall JC, Bird AR, Azari MF. Foot posture, leg length discrepancy and low back pain – Their relationship and clinical management using foot orthoses – An overview. The Foot. 2014/06/01/ 2014;24(2):75-80. doi:https://doi.org/10.1016/j.foot.2014.03.004
5. Pejin Z. Femoral lengthening in children and adolescents. Orthopaedics & Traumatology: Surgery & Research. 2017/02/01/ 2017;103(1, Supplement):S143-S149. doi:https://doi.org/10.1016/j.otsr.2016.05.020