2023-12-30 08:53:28
by Cesare Faldini
If the difference is between one and two centimeters, it must be evaluated on a case-by-case basis: the pelvis can function as a barbell, compensating for the discrepancy, especially if this occurred in childhood or slowly during growth.
Are there prostheses capable of rebalancing, especially for physical activity, the length of my legs which in my case have different measurements, even if only for a few millimetres?
Cesare Faldini, director of the First Orthopedic Clinic, Rizzoli Institute, responds; full professor at the University of Bologna (GO TO THE FORUM)
The different length of the legs is called dysmetria or heterometria. If less than one centimeter, it is so frequent that it can be considered a variant of normality: in fact the pelvis, to which the legs are attached, can act as a balance by tilting slightly towards the shorter limb without any functional consequence, as the spine compensates with a slight curve that has nothing to do with scoliosis. For this reason, it is inadvisable to correct millimeter discrepancies: they are irrelevant, the organism is adaptable and almost everyone has them. If the difference in length is between one and two centimeters, it must be evaluated on a case-by-case basis: the pelvis can still function as a barbell, compensating for the discrepancy, especially if this occurred in childhood or slowly during growth.
Rise in the shoe
In a patient who has developed it suddenly (following a fracture or prosthetic surgery), it can be compensated with a simple cork insole of adequate thickness inside the shoe (be careful of the silicone heel cups, which get crushed). We tend to correct 0.5-1 cm less than the defect, in order to still exploit the rocker effect of the pelvis, avoiding unnecessary bulk in the shoes. Discrepancy greater than two centimeters must be corrected with a lift, otherwise the excessive inclination of the pelvis causes the spine to be overloaded with a large compensation curve. The internal footbed can reach approximately 1.5 centimetres, if this is not enough it can be integrated with an external heel to be glued onto the sole.
Surgery
If the discrepancy requires an unacceptable elevation, it is possible to think of a surgical solution: the long limb is shortened by removing a small cylinder of bone from the femur or tibia and performing a fixation, or the short limb is lengthened with the external fixator or with a magnetic intramedullary nail: after having sectioned the bone in the operating room, the two fragments are moved away very slowly (about 1 mm per day) from the external fixator or the magnetic nail, until the desired growth is obtained. In this way, significant length differences (greater than 10 cm) are recovered, but the treatments can last from 6-8 months to over a year, depending on the extent of the lengthening.
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December 30, 2023 (changed December 30, 2023 | 07:53)
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