Leg lengthening

The causes of leg length differences can be congenital, growth-related or the result of accidents or injury. Growth-related leg shortening sometimes becomes noticeable as early as infancy. The length difference then usually increases continuously until the completion of leg growth, and can affect both the upper and lower legs and the foot. Injury to a growth plate in childhood can cause the leg to lag behind in growth quite considerably. Depending on the severity of the injury and the extent of the growth retardation, slight shortenings of a few centimeters but also quite considerable shortenings of over 20 cm can result. In most cases, there is also more or less pronounced axial or rotational deformities of the leg, which are not always immediately visible. Untreated leg length discrepancies lead to a pelvic obliquity and thus to an incorrect posture of the spine. Undetected or untreated axial or rotational deviations lead to unfavorable joint loads, cartilage damage and premature joint wear. Comprehensive diagnostics at ZEM-Germany provide clarity at an early stage.

With children - the right concept at the right time

If there are signs of a deformity or a leg length discrepancy, it is important to have an accurate clarification of the nature of the problem and its natural course, because it is important to avoid subsequent damage. With children, the right time for treatment is especially important, because sometimes there is only a small window of opportunity. In most cases, however, it is advisable to wait until leg growth is complete so that differences compared to the normal side are easily measured, and will not change. In any case, it must be ensured that an overall concept is available before treatment is started. A shortening of the leg without deformity can often be compensated for in a child without any problems initially by using a shoe lift. Early lengthening with an external fixator is therefore only necessary in exceptional cases. However, if a shoe lift becomes increasingly problematic, it should be clarified whether an intramedullary distraction nail can also be used advantageously at a growing age. However, there is a lot to consider when using distraction nails in growing children particularly, and the experience of the surgeon is crucial.

If growth retardation of the "healthy" leg is recommended, this should be questioned extremely critically. In view of new surgical techniques, there are very few indications for this.

Leg length discrepancies can cause chronic back pain and should be corrected in adults at an early stage before irreparable damage has occurred. Leg length differences of up to one centimeter are still considered physiological, although many people already perceive a misalignment. Between 1 and 2 cm, a permanent shoe insert or sole lift is usually recommended, which is not an acceptable option when changing shoes frequently, wearing safety shoes or when doing sports. Surgical leg length correction treats the cause, removes the need for shoe modifications, and is a safe, low-risk operation in a specialized center. Whether shortening the longer leg or lengthening the shorter leg is more beneficial depends on many parameters, such as whether there are additional deformities on one side that also need to be corrected. Usually it is the shorter leg that also has an axis deviation, so that lengthening in combination with axis correction is the better solution. This is often the problem, because the complex problem is not recognized or is not treated consistently. Thanks to modern planning and minimally invasive surgical techniques developed at ZEM-Germany, distraction nails are quite capable of correcting even complex deformities and shortenings in a single operation. So if in doubt, seek a second opinion before deciding to have surgery. Distraction nails in the hands of experts have decisive advantages compared to external fixators and leave hardly any visible scars.

The only thing that matters is the experience of the surgeon

Distraction nails were already routinely used at ZEM-Germany when other clinics were not very familiar with this technique. This head start in experience makes ZEM-Germany the place to be when it comes to leg lengthening. It is crucial that every aspect of leg shape and function with all its geometric parameters (see leg geometry) is included in the operation planning right from the start. The axis of body weight load runs through the middle of the joints on the lower limb so that the load is distributed evenly. Deformities of joints leads to overloading of a portion of a joint, and thus to premature joint wear. Twisting is also detrimental, as the resulting shear forces also overload the joints and impair the gait pattern. When lengthening nails implanted in the bone are used, all geometric parameters must be kept in mind. A so-called "simple" lengthening is the exception. Lengthening is always an intervention affecting the integrity of the entire leg, and demands a lot of experience and surgical practice from your surgeon. You need two healthy, straight and equal-length legs your whole life long. Only entrust your legs to specialists who have a proven track record. Broad-based clinics certainly do a good job of providing comprehensive patient care, but whether they have enough experience in the special field of corrective and reconstructive limb surgery should be questioned carefully.

In contrast to external fixators, the path to the final result, with the exception of the length still to be achieved, is set irrevocably during the operation when distraction nails are used. Nevertheless, the subsequent distraction phase also requires the greatest attention. The cut bone is now pulled apart by about 1 mm every day so that new, autologous bone tissue can form in the widening gap. FITBONE distraction nails require only a small, lightweight control device for activation, which makes them easy to use. Electromagnetic waves penetrate the tissue without any problems, so that the energy input 3 times a day takes only 90 seconds and is completely painless. Only the increasing pressure on the adjacent joints can lead to temporary pain, especially at night. The newly formed bone made by one's own body by this process after solidification does not differ from normal natural bone growth, so that after completion of the treatment, full weight-bearing and participation in sports is possible again.

You can read more details about the treatment here.