Doug Brayton, a lieutenant commander in the U.S. Navy in Norfolk, Virginia, says he first noticed his left leg was shorter than his right when he was in college. It seemed minor then, and he thought he'd just have to live with it.

But in the years since, the limb length discrepancy – a term that’s also used to describe when a person’s arms aren’t of equal length – eventually led to inflammation and a burning pain in Brayton’s hip that he dulled with medication. “It was just a constant pain,” says the 35-year-old. He also dealt with occasional severe bouts of back pain from the one-inch leg length discrepancy.

Even a centimeter’s leg length difference can affect how one stands, walks and is able to move around, let alone the personal expectation and desire for symmetry many people have. People who have more significant limb length discrepancies also tend to spend more time on the long leg and put more weight on it. “Over time that leg often will wear out faster – that’s something called long leg arthritis,” says Dr. John Herzenberg, director the International Center for Limb Lengthening at Sinai Hospital of Baltimore and a clinical professor of orthopedics at University of Maryland Medical School. “The other thing people do is if they’re holding their pelvis crooked and their back crooked because they have one leg [that’s shorter], then over time a lot of them will develop back pain and hip pain and leg pain from being off-kilter.”



Brayton eventually saw a podiatrist who gave him a lift that went into his tennis shoes or combat boots that corrected the discrepancy. About a month after he started wearing the orthotic, he says the pain went away. But when he took off his footwear, the pain would return. “I would walk around on my left tiptoe,” he says. That, and the success of the orthotic, led him to seek a permanent solution; and he was referred to Herzenberg.

Brayton thinks the discrepancy is congenital, though he didn't notice it until later, and he doesn't trace it to any particular condition. Limb length discrepancy can be the result of a congenital issue, like hemihyperplasia – wherein one side of the body grows more than another. Or it can be “acquired,” like when a person breaks a leg and the mended bone heals short. Various factors may be considered when deciding how to address the discrepancy, in addition to how big it is. For instance, clinicians would need to consider whether it's progressively getting worse – as in the case of a child whose growth is increasing the limb length inequality – or if the short leg, or a bone in that leg, is also crooked. “Treatment has to be individualized,” Herzenberg says.

For many, a difference in limb length is so minute as to hardly be noticeable and doesn’t warrant treatment. “It is not unusual for an individual to have a small limb length inequality, and it’s thought to be negligible for most,” says Dr. Francois Lalonde, a pediatric orthopedic surgeon at CHOC Children’s Hospital in Orange, California.

In others, with a discrepancy of up to two centimeters, a shoe lift may be recommended. For a more minimal discrepancy in that range, a heel wedge inside the shoe may be sufficient, Lalonde says; but for a discrepancy on the higher side of that range, an external lift on the bottom of the shoe is typically needed.

However, especially where the discrepancy is more pronounced – and this is monitored both through regular measurement and predicted in patients who are still growing, and whose leg length difference is expected to increase – clinicians talk to many patients and their families about permanent surgical solutions. These essentially fall into two categories: shortening the longer leg, or lengthening the shorter leg.

source -http://health.usnews.com/health-care/patient-advice/articles/2017-08-15/what-to-do-when-one-leg-is-shorter-than-the-other