2 year old with legs with a difference in length of 1.5 cm - any experience?

[Homebird8]

I have to admit we only noticed around DS's 2nd birthday but his legs have a 1.5cm difference in length (as measured at the hospital). He's still very unsure walking (though he started at 14 months) and gets down on all fours to go down steps of only about 5cm.
He's been seen by an orthopaedic consultant at the hospital about 10 weeks ago and they x-rayed to get a baseline picture to compare against in the future but couldn't see any developmental abnormalities.
He has always seemed to tense when I'm changing his nappy and I request "legs apart" to wipe in his groin. He can let his left leg (the shorter one) go sideways to allow this but seems a bit unwilling.
He never complains of pain (at 2 1/2 year now) but he's the wobbliest child of his age I come across at 2 toddler groups and in the nursery he attends 2 mornings a week.
Anyone with any experience of a child with legs of slightly different lengths? Is his wobbliness or his lack of ambulatory confidence down to it? Is there anything I should watch for or do to help him? (He gets plenty of soft play and is by no means a sedentary child).

Hi Homebird,
Yes, DS has a discrepancy of about 5cms, and he's 5.
DS's discrepancy is part and parcel of a little bundle of things, like having no fibula and a 'one off' ankle and foot design, all defined as 'a congenital abnormality'
But you don't know yet, what the cause of your DS's discrepancy is.
When will you see the consultant again? Did you tell him / her about the nappy-changing thing?

Anyway - DS does manage very well. He has a shoe raise fitted, and is very agile and active. I have always encouraged him to climb, and develop his confidence and strength. But he was more wobbly than other children - still is.

Homebird - hi - my dd has a leg length difference. Hers was 3cm, with some extra hidden in the pelvis/hip). We knew she had a problem as she had a clot following heart surgery. It badly damaged her femoral artery and for a time they thought the leg wouldn't be viable. Long story short when she eventually walked at around 2 it was obviously shorter and also thinner. She was very unsteady and had physio for a while to strengthen the weak leg.

Are the ortho's going to keep a check on your ds as he grows to see if it's static? Dd's was initially 1.5 and extended to 3 as she grew as the arterial damage isn't repaired. She wore a shoe raise to protect her spine (uncorrected LLD can result in scoliosis). Have they sugeested a raise at all.

In 2005 at age 12, she had some surgery to slow the growth onher long leg and the short one is catching up.

Hope this helps

Hello Blu

Thanks Blu and Saggarmakersbottomknocker (do you know how awkward that is to type? )

They want to see DS again next January - but to return if I have further worries. The trouble is that the other children his age are now losing the wobbliness and he isn't. If anything he's even more cautious. It's not that he falls often, more that he doesn't trust himself. He can climb quite well as long as he can use all fours and his knees. It's the bi-ped stuff that isn't so good. I couldn't jump until I was four (and didn't catch a ball until I was six) so I'm not expecting great co-ordination.

I don't want to make a big thing of it. The reason I went to Dr in the first place was to have the best chance at protecting his spine. I mentioned this to the consultant and he agreed that it might become an issue but he didn't think it needed looking at for the moment. What I don't think I mentioned (because I foolishly forgot to write down all the things I was concerned about) was the nappy changing thing.

Do you think I should return to the Dr?

SMBK or Saggar is just fine lol!

Personally I would ask to be referred to an orthotist for a shoe raise. It made a huge difference to dd's walking. She did stairs on her bum for a long time.

The physio helped too. dd had physio for other issues as well but the leg stuff was things you could easily do at home, hopping and practising jumping with both feet for example. We used to do this over a skipping rope laid on the ground. Also playing hopscotch, swimming, kicking a ball.

It hadn't occurred to me that it's only coming down steps he has difficulty with. Up is fine as long as the step isn't too big for a child of his size (i.e. not a mountain!).

He sort of won't bend his knees or at least won't bend the knee of the leg he's leaving behind as he goes down a step. He'll do it on his feet as long as you're holding his hand or he can hold onto a post with both hands. A bannister isn't good enough. He also attempts to run (which looks like nearly controlled, not-falling-over at little more than walking speed) without bending his knees. Could it be completely unrelated to the leg length thing? (Thinking aloud)

hey up, smbk!

Homebird - I agree with the things Saggar has said. Was it clear from the x ray where the shortening is? DS's is all in his tibia, with a tiny bit in his femur. Is your DS's leg bowed at all, or is it as straight as the other?

What Saggar says about scoliosis is the reason DS had shoe raises - although the consultant said that at an early age they are so flexible that it doesn't make a significant difference long term if the discrepancy isn't corrected whilst they are so young. But DS did have a small raise onhis shoe - it can be done on lots of ordinary shoes, but you would need the help of an prthotist to get it right. they do it really well - they match the material of the sole of the shoe.

I have no idea about other causes of leg discrepancy, but if it seems to get more severe, or if the nappy-change effect gets more pronounced, I would defintiely go back.

afaik, there is nothing they would / could do about bone length difference at such a young age (there are a few options later on...) but I would be interested to know of there is a soft tissue issue wth your ds given the nappy-change effect that you have noticed.

Maybe you could ask your GP to refer your DS to the orthotics service to see if a small shoe raise would help?

x-posted with you, Homebird.

I honestly don't know. I have heard that sometimes tendons are responsible for keeping bones short, if they grow more slowly than bone, for e.g.

When you saw the consultant, had you noticed the stais effect and were you able to give that info?

There is a charity called STEPS that has a series of case studies about 'Lower limb Disorders'. On thoier website they have case studies and a busy (ish) message board - it is possible there would be a parent there who has experienced the same set of 'symptoms' your ds has.

Did the consultant give any clue to what it was all about?

Hi Blu,

What a useful lot of thoughts, questions and ideas! Thanks.

The consultant said that children naturally (as a part of normal development) get bowlegged and then knock-kneed (or was it the other way round) as they grow and get stronger in the year or two after starting to walk. He seems a little knock-kneed to me at the moment but it's interesting to note that he's a little shrimp of a child not robust like DS1(4). His (DS2) knees seem to be the widest parts of his legs but he eats really well so I'm not worried about his weight, he's just going to be little like me (6st 2lb and 5'2").

It didn't seem to be clear from the x-ray where the shortening was but thinking back, they did get me to hold him by the big toes (in one hand) and put one hand on his chest to help him to stay still for the x-ray. I wonder if doing this hid his natural inclination to hold his legs in a particular position?

I've never heard of "orthotics" until this evening - thanks for broadening my education! If I decide to go back to the GP I'll mention it. It sounds as if they're specialists who might be able to make some informed comment on his mobility too. I once had a friend whose brother was a gait analyst. Would someone looking at his gait be a possible too? Is this part of what an orthotist might do?

I'm interested in your experience of soft tissue damage. There's nothing to indicate this in his medical history but there may be a little insufficiency or something somewhere. How can they tell?

You know, the more I think about it the more I can't remember what I told them at the hospital. I'm pretty sure I didn't mention the nappy thing and I'm not sure about the steps issue either. It might make sense if I compile a list of observations over a few days to give me time to remember everything. (Are we all addled after having babies?)

Thanks for your info about STEPS. I've found their website and will have a good read.

Their site says

"Management of Lower Limb Deficiencies

None - Some deficiencies are so mild as to require no treatment or support. Minor leg length differences can be accepted at least for the first few years of life.

"Orthotic Support
A sole and heel raise may be required to equalize the two leg lengths. 'This is acceptable if it is not so much as to make the shoe cumbersome, heavy and ugly. A specially made shoe may be needed."

Maybe I'm worrying too much. I wasn't at all worried about the present when I took him to the hospital in January. I was just concerned about protecting his back in the future. Now however, it's becoming rapidly more obvious he's struggling compared with other children of his age so I just don't know...

I think I'll take a few days to write my list and have a good think about it. DH thinks I shouldn't be worried.

Thanks again Blu and SMBK

Glad you managed to decipher 'orthotics' from my terrible typing!

I have friends who have a dd who has had problems with tendons (which are included in 'soft tissue) which has affected her walking, and saw children being treated by our consultant who also had tendon trouble. it was just the observations you made about the nappy change and walking downstairs which made me think that possibly it couls be connected to his soft tissue as well as / rather than his bones.

Anyway, it sounds as if the STEPS website is re-assuring about minor discrepancies...so just monitor.

I alwas find it very helpful to write things down before appointments - I used to put it down to baby-brain, but now 'appointment amnesia' is the excuse!

Where abouts in the country are you?

Anyway, with a biggish discrepancy (and a shoe raise which is defintiely approaching 'cumbersome, heavy and ugly') DS has learned to ride his bike without stabilisers recently. He can't run properly, but he is deliriously happy at school and has a very active social life with his freinds. So....try not to worry.

Hi.

A difference in leg lengths can be very common. There can also be an ACTUAL shortening i.e. the bone in one leg is shorter than the other leg or an APPARANT shortening i.e. the hips are being pulled up at one side due to muscle tightening causing one leg to appear shorter.

If you lie your ds on the floor on his back, with his legs together and put your thumbs on his ankle bones you should see the difference, then feel his hip bones with your thumbs and look to see if they seem equal or if one seems higher. If one seems higher then your ds may have hip/muscular problems.

Have you noticed anything else unusual in your son's development?

My legs have a discrepancy of about that much, poss slightly more (in my case due to congenital hip dysplasia and corrective surgery). I've never been in pain with it - I'm not the sportiest person, but that probably has other reasons too (e.g. total lack of talent ). Could ride a bike, physical play, etc. etc.

Do make sure he gets some kind of shoe raise, insteps, whatever. I didn't have this until I pushed for it myself aged 21 (!) (after people in Germany had noted I 'walk funny') and the result is a lovely scoliosis. (I don't have a limp as such - if I'm tired, carrying a heavy bag or in a hurry my walk is a little lopsided, that's all).

Berolina, Thanks for your support and encouragement to find out if he needs a shoe raise / insteps. I'll definitely look into it. ~I don't want him to have more problems than those nature has dealt him.

I also have a total lack of sporting talent so I'm not expecting great things from either of my children in this arena!

Soph28, thanks for the ideas about checking for muscle problems with his hips. I'll check tomorrow when I'm doing a nappy!

As for other unusual things - he's got quite a good singing voice which I'd never have expected!

Blu,

Well done to your son for learning to ride a bike without stabilisers. Sounds like he's not going to let anything get in his way

The STEPS website also says about hip problems

"the signs to look for in the older child are unequal creases in the buttocks or thighs, difficulty in spreading the legs, inequality in leg length or abnormal gait."

Well I don't think he's got many creases anywhere due to being so scrawny but I'll look tomorrow. He doesn't spread his legs easy (good if he was a girl but I don't have any daughters) Definite inequality in leg length though only 1.5cm. And he walks like he's got sea legs on land!

I think this has answered my question. I need to write that list and make an appointment with his GP who is fantastic.

Hips are beginning to look heavily implicated, aren't they?

I don't know if physio can help with that?

Great to hear you have a supportive GP. Let us know how you get on

Well done to Little Blu with his bike! Check out dd on my profile. She got all grown up.

Hope you get some answers Homebird8. Keep us posted.

She's so lovely, Saggar. Growing up v fast, isn't she?

yes, DS is a regular little stuntman on his bike now. It makes me very happy to see him tearing round the park at the same speed as his friends. W did it via the 'no pedals' method. Will tackle swimming next - but that will have to be DP's department. i do the calorie replensishment without the running (from your profile) and won't be seen in a cossie, atm!

Sorry for hijack, Homebird - but you see there is a tight network of those of us with children with leg-length discrepancies. So just shout when anything springs to mind!

Hello you wonderful helpful people!

I've had a look at leg creases (from the STEPS site) this morning and he does have an extra one on the longer leg. Is this because he's trying to squish his longer leg down to make it more even to his shorter one?

Tried the spreading the legs thing at nappy time this morning but he seemed perfectly happy to do it today and let both legs flop easily. Contrary child!

I think you're right though Blu: hips are starting to look heavily implicated.

Soph28, I'd forgotten what it was you said to try before I logged on again this morning but at next opportunity I'll check for a difference in hip height when his ankles are together.

Thanks again everyone

Yes, Soph28 explained much btter than me about the difference between bone length and what i refer to as 'soft tissue issues'.

I think that's why I was wondering whether you had been offered any physio.

Hi folks

Tried the lining up the ankles and trying to see if the hips were crooked but couldn't work out really what I was seeing. The inside ankle knobbles sit neatly one above the other when his legs are straight but to line up the ankles his legs have to be tilted to his left (i.e. not directly under his trunk.)

Not been offered physio. The hospital seemed to scratch their heads saying I wasn't going bonkers and there definitely was a difference in leg length but come back in a year.

They never seem to rush in orthopaedics lol!

It's not something they would do anything about surgically until your ds almost fully grown, unless there is a malformation in the hip. And then they tend to leave anything under 1.5cm so it depends if it progresses.
But if it's soft tissue then I'm sure physio would help and a raise would help him use all his muscles more evenly.

Was it a paed ortho you saw Hombird?

The nitty gritty of dd's difference wasn't really pinned down until she had a CT scan, really it was pretty much 'guesstimation' before that.

Blu - we did that with the pedals for dd. Wish I'd thought about it sooner and then ds2 might have got to grips with his bike before he hit 12!

Homebird- what you need to do is when the 'ankle knobbles sit neatly one above the other when his legs are straight' just leave his legs like that- don't try and straighten them- and then make a fist with each of your hands and stick your thumbs out, then try and place each of your thumbs on his hib bones (the most stickiest out part on his pelvis- not at the side, on the front), then just look at where your thumbs are and try to see if one seems a bit higher than the other.

sorry sounds a bit complicated but it isn't really

Aah, thanks Soph28. I'll have a go at the next opportunity. DS2 is currently building a bonfire! Yikes!

After following Soph28's advice, I can't see any difference in the levels of his hips when both legs are naturally extended. What does this mean?