Leg Length Discrepancy and Lower Limb Deformity

Care for Limb Differences

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Leg length discrepancies and lower limb deformities range from minor differences in limb length to significant overgrowth or undergrowth of a leg. In some cases, these conditions may be painful and make it hard for your child to be active. Our team of pediatric orthopaedic experts specializes in identifying these conditions and choosing the appropriate treatments to correct limb length differences, straighten misaligned limbs, and restore strength and function.

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About Leg Length Discrepancy and Limb Deformity

Limb differences such as leg length discrepancies and lower limb deformities can be present at birth or may be caused by growth or hormonal disorders, trauma, or a bone infection. Minor issues may resolve as a child grows, while others may worsen and require physical therapy, surgery, or another intervention. The following types are the most common. 

Leg Length Discrepancy

Minor differences in leg length may be noticed when a child is young. Some children may only need monitoring, but if a leg length difference reaches two centimeters or more, treatment should be considered.

Bowlegs and Knock Knees

Angular deformities occur when a limb is not properly aligned. They are common in young children and often resolve on their own by the time a child is seven or eight years old. Bowlegs (knees that are wide apart when feet are together) and knock knees (knees that touch while the feet and ankles are wide apart) are common angular deformities. 

Congenital Lower Limb Deformity

A congenital lower limb deformity occurs when a leg doesn’t develop normally as a baby grows in the uterus. At birth, one leg may be much longer or shorter than the other or missing altogether.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Evaluation for Leg Length Discrepancy and Limb Deformity

Because leg length discrepancies and lower limb deformities can affect your child’s physical, social, and emotional growth, it is important that they undergo a thorough exam and receive an accurate diagnosis so that treatment can begin as soon as possible.

Physical Exam

Your child’s pediatric orthopaedic doctor will perform a full-body physical exam to assess their condition and determine if it affects other areas of the body such as the spine. They will evaluate joint movement, ligament and muscle strength, reflexes, and more. Measurements are taken if a leg length discrepancy is present. 

Imaging Tests

In most cases, X-rays will confirm your child’s diagnosis and help the doctor develop a treatment plan. We use EOS technology whenever possible, which reduces radiation exposure by 50% to 85% compared with traditional X-rays.

Treatments for Leg Length Discrepancy and Limb Deformity

Based on the results of your child’s evaluation, your doctor may recommend one of the following treatments.


Custom leg braces may be effective for treating some limb deformities present at birth and for angular disorders such as bowlegs. Braces may be used in combination with other treatments.

Growth Modulation

Younger children with angular deformities may be candidates for growth modulation. During this minimally invasive procedure, a small plate -- about the size of a paperclip -- is attached to the side of the affected bone with two screws. The plate helps straighten the bone as your child grows. It is removed after the correction is achieved. Your child must still be growing for this surgery to work. 

Limb Lengthening or Realignment Surgeries

During surgery, the affected bone is cut and an internal or external device is placed. In the weeks or months that follow, the cut bone is gradually pulled apart with the help of the device, and new bone grows in the gap. This process continues until the bone reaches the desired length. Your child will be fitted with one of these devices:

  • Internal lengthening nail: A telescopic, motorized nail or small rod is inserted into the marrow of the bone. With a remote-control device, a magnet in the nail is rotated a few times each day to gradually lengthen the bone. 
  • External fixator: A metal frame is placed around your child's leg and held in place by pins that go through the skin and into the bone. The fixator is adjusted daily over several months to slowly lengthen the bone.

Your child will use crutches or a walker for several weeks after surgery. When treatment is complete, the devices will be removed in a second surgery.

Physical Therapy 

Physical therapy is often an important part of your child’s treatment plan. It can help them stay flexible, increase muscle strength, restore mobility, and aid in recovery after surgery.

Best Orthopaedic Hospital in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

Family-Focused Care

Our team of pediatric orthopaedic experts understands living with leg length discrepancies and limb deformities can be stressful not just for your child, but for the entire family. We help you choose the right treatment and understand your role in the process. For example, if your child has limb-lengthening surgery, they will need help making daily adjustments to their device and with everyday tasks like getting in and out of bed. You will also make frequent visits to your child’s doctor to monitor their progress as they grow. We take the time to explain your child’s individual treatment plan -- and to answer your questions.

This page was medically reviewed on 03/24/2022