AskThePedipod
Farokh Wadia
What is Leg length discrepancy?
Mr Farokh Wadia, Consultant Paediatric Orthopaedic Surgeon
1 August 2026
A difference in leg length that can be monitored and, if needed, corrected as a child grows.
What is leg length discrepancy?
Leg length discrepancy is a difference in length between the two legs. Small differences are very common and usually cause no problems at all. Larger differences can affect walking, posture and the spine. Causes include previous injury or infection affecting a growth plate, certain conditions present from birth, and some bone or growth disorders.
Signs and symptoms
• A limp or uneven walking pattern
• Walking on the toes of the shorter side
• One hip or shoulder appearing higher than the other
• A visible difference in leg length
How is it diagnosed?
Assessment involves a clinical examination and specialised X-rays to measure the difference accurately. Because the discrepancy can change as a child grows, monitoring over time is often part of the assessment, and predictions can be made about what the difference will be at the end of growth.
Treatment options
Minor differences may need no treatment, or simply a shoe raise. Larger discrepancies can be managed in several ways depending on the size and the child’s remaining growth, including guided growth (a small procedure that slows the longer leg at the right time so the shorter leg catches up), or limb lengthening or shortening procedures. The plan is tailored to the predicted final difference.
Outlook
With accurate prediction of final leg lengths, treatment can be planned and timed to achieve a balanced result by the time growth is complete.
When to seek advice
If you notice a limp, an uneven posture, or a visible difference in your child’s leg length.
This information is for general guidance only and is not a substitute for a consultation with Mr Wadia. If you are worried about your child, please seek medical advice.
FAQs
How is a leg length discrepancy treated in growing children?
A leg length discrepancy is treated based on the predicted final difference in leg lengths at skeletal maturity, ranging from simple shoe lifts for minor variances to minimally invasive growth-slowing surgeries for larger differences. The goal of treatment is to equalize limb lengths before the child stops growing to prevent a limp, compensatory scoliosis, and premature joint wear.
Core options for managing unequal leg lengths:
Conservative management: Using a custom shoe lift inside or outside the shoe for discrepancies under 2 cm to maintain a balanced pelvis.
Guided growth (Epiphysiodesis): A straightforward, minimally invasive procedure using plates or screws to temporarily slow down the growth plate of the longer leg, allowing the shorter leg to catch up naturally as the child grows.
Surgical limb lengthening: Specialized, gradual surgical bone lengthening reserved for severe discrepancies typically greater than 4 to 5 cm.