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Customized Insoles For Limb Length Discrepancy

Limb length or Leg length discrepancy or leg shortening is the inequality between the lengths of the person’s arms or legs. Excluding the rare cases, inequality in arm's length doesn’t usually impact the function of arms and usually does not require any kind of treatment.

But however, a discrepancy in leg length, usually becomes clear to parents as their child grows and starts to walk on his/her own.

It is an astonishing fact that only 25 % people in the world with two legs actually have equal length of legs. In most of the cases, the difference between the two is diminutive and the person will likely go his/her entire life cycle without even being aware of the incongruity as well as also not being affected by it.

It has been found out that the differences in length of over 2 cm are rare. Some children are affected by leg shortening since their birth. While in many other cases, some kind of prolonged illness or even an injury causes a discrepancy in length to develop over the gradual period of time.

An inequality of minimal degree may not cause symptoms, but a significant difference between the two can cause a discernible hobble and make it difficult for a child to play, run or walk.

Treatment for a discrepancy varies according to the extent of the leg shortening. In a lot of cases, an insignificant difference in leg length can be covered by wearing a lift in the shoe of the shorter leg. A child with a more significant difference, however, may benefit from surgery to make his or her legs the same length.

This can be done in a number of ways, but is most often accomplished through a procedure that delays or eventually stops growth in the longer leg.

Following are two major classifications of leg length discrepancy:

• Structural differences are found due to inequality in length measurement, normally because of unevenness in the length of the femur present in the thigh or the tibia and fibula bones present in the lower leg.
  
  This may be a defect from birth or it may occur after an accident in the leg, the serious infection of any wound in the leg, or any kind of local damage to one of the plates responsible for growth in a leg.
  

• The other, much general, type is observed when the legs themselves are of the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or one hip is a bit higher and tighter than the other one (known as hypertonicity in the muscle structure of the pelvis or leg).
  
  This shortened leg possessing tightened muscles causes the legs do seem to be different lengths, even though careful measurement would show no inequality between the lengths of the actual leg. This is known as leg length alignment asymmetry (LLAA) and can be seen when the person is lying down.

How Does Leg Length Discrepancy Occur?

At first sight, a back pain or lower leg discomfort in the patient could be a symptom of leg length shortening and a lack of leg length symmetry issue. Lack of Leg length symmetries appears to be the third most general symptom of injuries caused by running and occurs in 60 to 90 % of the population.

While classifying leg length discrepancy, it could be divided into two primary categories: structural and functional.

Structural

Structural deformities occur due to biological shortening of bones.

Sometimes from a growth plate injury occurring in childhood or teenage.

A fracture or other bone injury: an injury to the bone can delay the rate of its growth, while simultaneously the bone in the other leg continues to grow at a normal rate. Some fractures can also result in the extended growth of bone during the healing process, usually with injuries to the thigh bone.

Chances are greater to happen if the bone was broken into multiple pieces. Also, if the skin and muscle tissue surrounding the bone were injured and exposed to a high magnitude, as it may occur in an open fracture.

Diseases of the bone: Osteomyelitis or various similar diseases can damage the growth plate present in the bone, causing a shortening that results in an observable difference, gradually over time.

Some bone diseases may cause limb length shortening, including:

• Multiple hereditary exostoses.
• Ollier disease.
• Neurofibromatosis.
• Bone Tumors and its treatment process can cause a leg length discrepancy too.
• Hemihypertrophy (one side too huge) and hemiatrophy (one side too little) are some extremely exceptional physical conditions that may add to the length error. In patients affected by these deformities, the arm and leg on one side of the body are more unequal (either longer or shorter) than the arm and leg on the counterpart side. A difference between the two sides of the face may also be observed. In several cases, it is possible that the exact cause of these conditions cannot even be determined. It is also termed as “Idiopathic” or in simple terms unknown.
• Juvenile Arthritis: Inflammation of bone during growth.
• Spinal abnormality such as scoliosis.
• Bone infections occurring in growing children may affect limb length discrepancy significantly. This is mostly true if the infection happens in the infant stage of development.

Functional

• Functional leg length discrepancy normally occurs due to muscle weakness.
• Inflexibility at the pelvis or foot and ankle complex.
• Pelvic obliquity.
• Equinovarus and rearfoot pronation.
• Adduction or flexion contractures of the hip, genu varum.
• Responsible environmental factors such as drainage crowns transformed into roadways banked running surfaces, and excessive wearing out of shoes can create a situation that can simulate the leg length difference.
• Mode of running of an athlete.
• Shifting of the center of gravity towards the shorter leg.
• A backache.
• The compensations associated with leg length discrepancy:
• Pelvic tilt (to the short side),
• Lumbar scoliosis (convex to the short side),
• Knee flexion (increased on the elongated side),
• Genu recurvatum (on the short side),
• Subtalar joint pronation (on the elongated side),
• Ankle plantar flexion,
• Foot supination (on the short side).
  

Some other causes affecting the lower extremity with a structural deformity usually appear first on the long leg side and include

• Flank pain
• Arthritis of the knee,
• Psoriasis,
• Arthritis of the hip,
• Patellar tendonitis,
• Plantar fasciitis,
• Medial tibial stress syndrome and Metatarsalgia.
• Patellofemoral pain syndrome

Symptoms affecting the short extremity include:

• Iliotibial band syndrome with lateral knee pain,
• Achilles tendinitis
• Trochanteric bursitis,
• Sacroiliac discomfort,
• Cuboid syndrome.
  

If the patient has only functional Leg Length Discrepancy, the shorter side will show symptoms earlier and may include:

• Plantar fasciitis,
• Patellofemoral pain syndrome,
• Ipsilateral sacroiliac discomfort with contralateral low back pain,
• Secondary psoriasis,
• Iliotibial band syndrome
• Medial tibial stress syndrome.

The best treatment for leg shortening

• Epiphysiodesis:
  
  Epiphysiodesis is a trustworthy treatment method that stops the growth of the longer leg. It is advised against the skeletally mature patients, and the final leg length discrepancy and the extent of growth inhibition need to be predicted and are subject to errors.
  
  Because the procedure effectively shortens the longer leg and is commonly performed on the unaffected side, it could be discomforting to the patient and his family.
  
  
• Shortening techniques
  
  can be performed after skeletal maturity to gain leg length equality. Shortening can be performed in the proximal femur using a  hip screw or blade plate, in the mid-diaphysis of the femur using a closed intramedullary technique or in the tibia.
  
  
• Non surgical treatments:
  
  If the patient’s leg length shortening is medium in magnitude, generally less than one inch, it is usually treated without the involvement of surgical options.
  
  
• Prosthetics:
  
  These devices may work well for some patients with a very large magnitude of deformities who would not benefit from other lengthening or shortening procedures being done to the affected person.
  
  
• Leg-shortening surgery:
  
  Procedures to shorten the longer leg are highly recommended for leg length discrepancies that are expected to be between two and six centimeters when the child grows up to adolescence.
  
  
• Bone resection:
  
  This operation includes displacing a section of bone in the longer leg so the legs are equal length. It can be done on adults or adolescents who are no longer developing in size.
  
  
• Internal fixation (PRECICE Nail):
  
  For this treatment, the bone in the shorter leg is dissected into two and the surgeon inserts a magnetic motor powered nail in the bone. The bone then gradually lengthens using an external magnetic circuit.

How Custom Insoles Help With Leg Shortening?

Custom insoles play a major role in the treatment of leg shortening. The help in:

• Proper foot alignment.
• Managing tissue stress level to a tolerable level.
• Gait analysis proves helpful in designing custom insoles, which works towards restoring normal mobility of the patient.
• Providing support to the shorter leg.
• Distributing body pressure, hence managing abnormality caused by length difference.
• Reduce the pain and discomfort caused while walking or playing.
• Proper fit for each individual as they are custom designed.
• The highly elastic material, molds according to the surface on which the individual is walking on

Orthotics 3D Custom Technology and Design

The insoles are manufactured from the thermoplastic polyurethane material that promotes both soft and non-binding components to be joined into a concluded insole. This process is still used at a large level throughout the orthotics design industry.

The orthotics are an amazingly manufactured, fitted into the individual’s shoe. Commonly known as  "orthotics", these orthoses give the hold for the foot by re-assigning ground reaction forces as well as re-positioning joints while any physical mobility like walking, running or various other motor displacements.

A very scientific conclusion is that the orthotics might be used to treat people with foot problems as well as they have the impact on various other spine and back-related discrepancies are just extraordinary.

They are used by almost everyone affected from leg length discrepancy ranging from athletes to the elderly people, for the function of enhancing mobility, motor capabilities and for healing a vast variety of soft tissue inflammatory conditions.

Hence, when used in association with suitable orthopedic footwear, they act in the prevention of leg pain and discomfort caused in LLD.

As we know how leg length discrepancy shoe insoles can add to your comfort and health, and the crucial role comfortable and correctly-fitting leg length discrepancy insoles can make.

Leg-Shortening Insoles

In case of leg length discrepancy, instead of making leg discrepancy insoles, science has further been enriched to manufacture leg shortening insoles, which can be applied to the longer length instead of the shorter one.

Leg shortening insoles are designed to delay the growing process of the longer leg. Hence, effectively removing the inequality in a long duration of time. Leg shortening insoles are hard to design and require complex processes, which are carried out by subject experts.

They sometimes are available with a nano-molecular structure which could be custom designed according to the condition of the leg, individual’s metabolism and leg length structure. If the leg length difference is higher than 2 centimeters, it is not advised to use these insoles.

Benefits

• Relief from any kind of discomfort or pain.
• Enhanced mobility and freedom in walking/playing or just standing.
• Proper body support.
• Weight distribution.
• No limp while walking.
• Easy lifestyle.