Leg length discrepancy

[emmaand3]

First time posting on this, so please bear with me - this is all new to me.

My dd who is 21months has only just started walking, we have been aware that her 'creases' were not symetrical since 9mths and the HV was keeping an eye on it. Now that she has started walking it shows that she has a limp in her left leg. Went to GP referred to physio who said she has a leg length discrpancy of at least to 2cm. She was then referred to orthotics.

After seeing GP again he has referred to peads aswell, her speech is also a little delayed. The gp said he can feel that her right hip is crunching. This leg also has a very deep crease that isnt on the other leg.

I am seeing the orthotics on Monday, what should I expect and what should I be asking.

Thanks

[beautifulgirls]

Orthotics or orthopaedics? The former will be to do with shoe inserts/adaptations etc, the latter to do with medical/surgical care of bones. If you are not already on the list to see a paediatric orthopaedic surgeon then I would insist that you are seeing one asap. It may not be relevant to do anything right now from their point of view, but it could be essential to treatment in the future to time it properly too as she grows. At least if you see them then will be able to try and see exactly what is going for a start here and help you make a plan.

[chatee]

hiya
i am a mum to a dd with a leg length discrepancy and who was born with a dislocated hip so i hope i can 'share' a little with you and ease your mind until you get the chance to see a health care professional.

2cm at 21 months to me is quite a large discrepancy(imho)- who has measured this and how was this done? as it is actually quite difficult to measure a lld and even more so in a young child...mri, xray or cat scan is the most accurate measurement process not a tape measure!

I would suggest you ask for an immediate referral to a paediatric orthopaedic specialist either based at a childrens hospital or at a specialist orthopaedic hospital, a referral to a general paed (normally at a local hospital is fine, but they are 'generally just the gate opener to other specialists' so rather than waiting get yourself referred now..

has your dd been checked for dislocated hips as uneven creases and a lld are clear markers for this? again xray not just physical man handling by a gp at 6 weeks of age and a tick box checked!

orthotics- could be as simple as a pair of normal shoes being adapted by putting a raise on the shorter leg shoe to balance out to make equal lengths but this will also depend on the gait / balance that the child has when walking..ask for a gait analysis if concerned
or specialist footwear maybe provided if there is a need but this is always a last option as it is expensive and childrens (especially young children)grow so quickly that by the time the prescription footwear is ready the child will nearly have grown out of them..
was your dd early, breech or a csection delivery by any chance?(you don't have to answer that if you don't want to- but apparently quite common in first born girls)
good luck, shout if you have any questions and i hope it all goes well on monday xx

[emmaand3]

Thank you beautifulgirls, yes defo orthotics on monday the physio said on the phone to me today that the pead consultant (appt in 2 weeks) will just prob refer to orthopaedic peads. The physio also mentioned an MRI scan and Im guessing as she is under two and she would not stay still would have to have a general aneasthetic for this. It is all very worrying.

[emmaand3]

Thanks Chatee

It is great to hear from someone who has experience of this. Erin is my third child, normal delivery a couple of weeks early as she was getting very big. She was 9lb born 2.5 weeks early.

She hasnt had any scans as yet, the physio measured with a tape measure, the gp is worried about hip and seems to be focussing on that more than leg length. Thats why I am concerned that she is still being allowed to walk around on it for another couple of weeks before the appt. It seems to me that scans should be done before the appt but nothing has been arranged yet.

She walks very strangley, dragging the longer leg behind. It is very clear when you look at her that the left leg has to be bent and the right leg is very straight. She never appears to be in any pain atall though.

How is your LO and does the LLD cause her any problems?

[saggarmakersbottomknocker]

Hi emmaand3. My dd has an LLD caused by a clot in her main leg artery as a baby. The clot caused an issue with the blood flow and stunted the growth of her long bones.

It sounds as though your dd's may be caused by a hip issue as opposed to a long bone issue so if they can correct the hip that will lessen the LLD.

Orthotics is a good start - a shoe raise will help correct her gait and level her hips. Misaligned hips can cause pain and scoliosis. Agree with chatee though -insist on a paeds orthopaedics referral to get proper x-rays and scans done. IME it's initially a CT scan rather than an MRI and it actually takes a very short length of time to do so she'll probably be fine without any sort of sedation - dd's were often quicker than the x-rays.

If it is more of a long bone problem than a hip one (it's more likely hip I would think) give me a shout (you can use 'message poster') as dd has had corrective surgery on her long bones.

[chatee]

good luck for tomorrow, remember to take some favourite toys/books/snacks and take another adult familiar to your dd to help you, as if she is sat on your knee being 'poked and prodded' by orthotist then your other adult can pick up/pass things to your dd as and when she throws them! and you can concentrate on your dd (if upset) and listening to the orthotist..

my dd is now 11 and her lld is reviewed every year atm(due back next week but postponed it as she just started secondary so now going in october)and is controlled by a heel raise on shoes and inside shoes, but she could face the prospect of an op in the next 12-18 months and again when she 'stops'growing or nearly stopping!

have a look at the steps website for info on different topics but i do agree that it sounds more like a 'hip' issue than a leg and yes if it needs treatment it will be daunting at first but just think about it in the long term picture, 6 months(if that long) is only a fraction of a life time and your dd won't even remember it- it's the adults that are traumatised!

Hugs n keep in touch xx

[saggarmakersbottomknocker]

chatee - will dd possibly be having the epiphysiodesis surgery? dd had that so let me know if I can help with any info. She's almost 18 now; the surgery corrected a 3.5cm lld.

[Littleeds]

My DS has a LLD, and I did my own research using the Steps Charity website www.steps-charity.org.uk/. I went to the GP and asked that he was referred to a Physio. The GP also then suggested orthics and the paed orthopaedics. Each of these has looked at different aspects the LLD.

[ladylush]

Sorry not much knowledge on this topic - had a look because dd has CP and her recent ultrasound showed mild subluxation of the hip.

But I'd like to offer you some reassurance - not all units will anaesthetise a child pre-MRI. dd had an MRI when she was 18 months old and was sedated with an oral liquid (think it was a barbiturate). It was very successful - in a deep sleep throughout the procedure. Had to keep a close eye on her after though as she was falling about all over the place!

[tiredoffightingwithjelly]

I think ladylush maybe referring to medazolam - our son had this alone prior to a lumbar puncture and more recently as a premed before GA to keep him calm. He has had GA around seven or eight times in the last five weeks and I have been worried every time but he has been fine, try not to worry too much.

[ladylush]

The sedative used was Chloral Hydrate