LEG LENGTHENING & ARM LENGTHENING FOR CHILDREN
The medical team at Medical City Children’s Orthopedics & Spine Specialists has vast expertise in unique and special Arm and Leg Lengthening procedures. Parents should bring their children to us as soon as it is noticed. Then we can correct the condition and your child can run, play and act as all kids do.
Some leg lengthening and arm lengthening conditions are better treated early while growth potential is still possible.
Leg Lengthening
We recommend early treatment for children and adolescents with one leg much shorter than the other
“When the discrepancy is warranted, we may recommend using guided growth where we help tether the growth plate to slow down the long leg to allow the short leg to catch up. If the discrepancy is more than three inches, we discuss lengthening operations on the shorter leg.” Shyam Kishan, MD
Leg Lengthening & Arm Lengthening for Children – Height Growth Operations
Arm and leg lengthening for children refers to a surgical procedure. This procedure increases the length of a shorter limb for even growth and enhances gait and function. It provides a procedure when your child has a notable difference in the lengths of their arms or legs. Differences in leg or arm length can lead to nerve damage, dislocations, joint contractures, and muscle damage, among others. The procedures, performed by orthopedic surgeons, will ensure that your child’s limbs become the same length while getting perfect care.
At Medical City Children’s Orthopedics and Spine Specialists, we believe every child is different and special, so we ensure that each case provides the correct solutions with accuracy and precision. For children and adolescents, our successes in height growth operations and arm and leg-lengthening procedures have been recognized globally. Dr. Shyam Kishen leads the team, and his peers consider him a leading expert in this field.
How Does Leg Lengthening Differ from Arm Lengthening?
Though doctors can lengthen both arms and legs using similar surgical techniques, there are a few key distinctions.
First, the impact of length differences appears more significant in the legs. Even a small imbalance between leg lengths can affect your child’s ability to walk, run, or maintain proper posture. With arms, differences typically become a concern when they affect day-to-day activities. For instance, buttoning a shirt, riding a bike, or comfortably resting an arm on a desk.
Additionally, the types of medical devices used may vary. For leg lengthening, we often use internal rods (fixators) when the bone is wide and strong enough. This offers stability for weight-bearing bones. However, in the arms, especially for growing children whose bones continue to develop, external devices are sometimes the safer and more effective choice.
Our team carefully evaluates each child to determine the safest and most effective method for their unique needs. We ensure both arms and legs are given the expert care they deserve.
When Should You Consider Leg and Arm Lengthening Surgery for Children?
Treatment of limb length discrepancies depends on the variance in the length of the arms or legs. Not all limb length variations require Height Lengthening Surgery or treatment. However, if the difference becomes very obvious and limiting, doctors will recommend Bone Extension treatment as soon as possible, especially for young children.
QUESTIONS AND ANSWERS
Why do some children need limb lengthening?
- Limb Length Discrepancy: Limb lengthening is often recommended for children with a significant limb length discrepancy, where one limb appears shorter than the other. This discrepancy can result from congenital factors, growth plate injuries, or other medical conditions.
- Deformities: Children with limb deformities may also require limb lengthening to correct the deformity and ensure that the affected limb functions properly.
- Cosmetic Considerations: In some cases, limb lengthening may occur for cosmetic reasons, especially in cases of shorter stature.
How is limb lengthening in children performed, and what is the process?
- Surgical Procedure: Limb lengthening is typically performed through a surgical procedure. The surgeon makes a controlled cut in the bone, and a specialized device, such as an external fixator, is attached to the bone. This device gradually stretches the bone over time.
- Distraction Phase: The process involves two phases—the distraction phase and the consolidation phase. During the distraction phase, the device is adjusted daily to slowly separate the bone segments, allowing new bone to form in the gap.
- Consolidation Phase: After achieving the desired length, the consolidation phase involves allowing the newly formed bone to solidify, a process that may take several months.
- Rehabilitation: Physical therapy is often an essential part of the process to help the child regain strength and mobility in the affected limb.
What are the potential risks and outcomes of limb lengthening in children?
- Risks: Limb lengthening is a complex procedure and carries certain risks, including infection, complications with the device, nerve or blood vessel damage, or a prolonged recovery period. Some of the most common complications involve infection around the pins that attach the external device to the bone. With internal fixators (devices placed inside the body), this particular risk is reduced, but other complications may still arise.
Other possible risks include:
- Pin-site infection
- Muscle contractions or stiffness
- Joint dislocation
- Blood vessel or nerve injury
- Delayed or accelerated bone formation
- Problems with bone healing, such as bone non-union (when the bone ends do not join together)
Because of these potential complications, your child will need frequent follow-up visits with their surgeon during the lengthening process. The healthcare team will closely monitor the healing bone, surrounding muscles, and joints, and can intervene promptly if any issues develop.
What are the Causes of Variation in Leg and Arm Length?
Some of the most common causes of discrepancies in limb length are:
- Birth defects like Congenital bowing of the tibia bone
- Trauma to Growth Plates
- Illnesses like Polio
- Bone Infection
- Bone Diseases like Neurofibromatosis
- Joint Inflammations like Juvenile Arthritis
In cases involving dwarfism, it causes short stature, limb deformities of different kinds, and functional limitations. As such, height growth and arm and leg lengthening in children’s operations can correct some of these problems.
Previous injury to one of the bones in the leg
Leg fractures can cause differences in the length of the legs if the affected leg heals in a shortened position. This usually happens if the bone breaks into many pieces, or if a compound fracture occurs — where the bone breaks through the skin and muscle tissue around the affected bone gets badly injured.
In a child, a broken bone sometimes grows faster for many years after it heals. Sometimes, it makes it grow longer than the bone on the other leg. In addition, this form of overgrowth usually occurs in young children with thighbone fractures. A fracture occurring in a child’s growth plate — near the end of the bone — may cause slower growth. This sometimes leads to a shorter leg.
Other causes include:
- Conditions like joint inflammation during growth (such as juvenile arthritis)
- Neurological conditions
These conditions are often found at birth, but the doctor may believe that the difference in the length of the limb does not need treatment at that point. As the child grows, if the difference in length increases and becomes noticeable, a treatment program can begin. In such cases, one of the two bones found between the knee and the ankle becomes abnormally short. Also, foot or knee problems may cause leg length differences in children.
How is Pain Managed During and After Limb Lengthening Surgery?
- Pain Management: Managing discomfort is a top priority during the recovery period. After surgery, children may experience some pain or soreness, particularly in the initial weeks. Our clinical team employs a combination of pain-relief strategies tailored to each child’s needs. This may include oral medications, localized treatments, or, in certain cases, nerve blocks recommended by the anesthesiology team.
- Ongoing Support: As the lengthening process progresses, children may notice their muscles feeling tight or achy. Regular adjustments to the device are generally not described as painful, but can cause temporary discomfort. Our team works closely with your child to minimize pain.
- At-Home Care: Parents also play an important role in monitoring comfort levels at home. We provide guidance on how to manage mild soreness, like applying ice packs, using prescribed stretches, or following medication instructions. This collaborative approach helps ensure your child remains as comfortable as possible throughout their healing journey.
How Much Can a Bone be Lengthened in One Procedure?
The potential lengthening that can occur in a single procedure depends on several important factors. These include your child’s age, the type and size of the bone, and the overall health of the limb. Generally speaking:
- For most children, surgeons can safely lengthen a limb by up to 2 inches (about 5 centimeters) during one treatment cycle.
- When the limb length difference exceeds this amount, additional procedures, spaced over months or years, may continue for gradual correction.
- Bones in the arms and legs respond differently to treatment. As a guideline, legs are often lengthened up to about a quarter (25%) of their original length. While arms may tolerate a lengthening of up to 40% of their original bone size per cycle.
Ultimately, each case is unique. The surgical team will carefully assess your child’s situation to recommend a lengthening plan. The plan will balance the desired outcomes with safety and long-term mobility.
How strong is the new bone after limb lengthening?
- Bone Strength: Once the newly formed bone matures completely, it becomes just as sturdy and resilient as any other bone in your child’s body.
- Return to Activity: After proper healing, most children are able to return to their usual activities, sports, and play without any added risk of fracture or weakness in the lengthened bone.
- Long-Term Durability: With ongoing follow-up and care, the new bone maintains its strength for years to come, allowing your child to move, run, and explore as they did before, just with legs or arms now at a matching length.
Bone infection
A bone infection that occurs in growing children can lead to a difference in limb length. Furthermore, this usually occurs if the infection occurs in infancy.
Dysplasias (bone disease)
Some bone diseases can lead to discrepancies in arm or leg length. Such diseases include:
- Multiple hereditary exostoses
- Neurofibromatosis
- Ollier disease
Bone diseases can also lead to knock knees. Knock knees usually develop in most children around the age of 3, and they often grow out of it between the ages of 8 and 9 years.
How Are Leg and Arm Length Differences Diagnosed?
Most of the time, parents or the child’s doctor recognize these limb differences. Once determined, the parents will see a pediatric orthopedic surgeon who will verify the differences and the severity. To begin, the first step in diagnosing limb length variation and severity occurs with the help of an X-ray or a simple clinical exam. Then, the tests usually occur once every six months to monitor the differences and determine the right time for any limb lengthening procedure.
Physical examination
The doctor will ask about the child’s health, medical history, and symptoms. Then the doctor will carry out a detailed exam while observing how the child sits, stands, and moves.
The physical exam involves:
Gait analysis
The doctor will observe the child’s gait (i.e., how the child walks). Children can compensate for differences in the length of their legs by walking on their toes or flexing their knees.
Measurement of leg discrepancy
While the child stands without shoes, the doctor will measure the discrepancy by placing wooden blocks under the short leg to make the hips level.
Imaging studies
X-rays
An X-ray shows images of bones. If the doctor wants a precise measurement of the discrepancy, he or she will request X-rays of the child’s legs.
Scanograms
This type of X-ray measures the length of the bones in the legs by using a series of three images and a ruler. Additionally, the doctor may need a scanogram in addition to an X-ray.
Computerized Tomography (CT) scans
These help to provide a more detailed image of the soft tissues and bones in the legs. The doctor usually uses a CT scan to measure the discrepancy in the limb length. As the child grows, the doctor may conduct further physical examinations and imaging studies every six months to one year to learn if the differences progress or remain the same.
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What are the Limb Lengthening for Children Treatment Options?
Doctors recommend several options for limb lengthening and height growth operations, but a child may require more than one treatment option to get the best result. At Medical City Children’s Orthopedics and Spine Specialists, our specialists evaluate your child’s situation and determine which options to use. By the way, while many believe that doctors only lengthen the legs, doctors also lengthen the arms.
Gradual Limb Lengthening for Children and Deformity Correction
This treatment option involves mounting an external fixator on a limb to lengthen or shorten it or repair a deformity. External fixators are of two types: circular rings that go around the exterior of the limb and a straight bar along one side of the limb. In addition, there is the fixator frame that remains on the outside of the limb and connects to the bone through pins and screws.
Once the surgeon puts the fixator in place, the surgeon then performs an osteotomy, which divides the bone. Then the doctor decides on where to divide the bone upon carefully evaluating the patient’s bone, connective tissue, and bone tissue, and the type of correction needed.
After the conclusion of the arm or leg lengthening surgery, the surgeons at Medical City Children’s Orthopedics & Spine Specialists show the parents how to adjust the fixator on their child’s limb. In addition, parents will adjust the fixator daily so the two parts of the divided bone can continually grow and gradually move into their new and correct position to lengthen the limb and increase the height of the child.
New bone grows in the gap between the two ends of the cut bone, and over time, the bone heals enough so that the doctors can remove the fixator from the limb in a quick procedure.
Epiphysiodesis
As mentioned earlier, a special layer of cartilage at each end of a bone is referred to as a growth plate, and it allows the bone to grow. When a child reaches adulthood, the growth plate becomes bone, and at this point, the bone no longer grows. This Epiphysiodesis process slows down the growth of a bone. By performing growth surgery, the surgeon will remove the growth plate of the longer limb. Upon the growth plate being removed from the longer limb, the shorter leg can catch up with the longer one over time. Only children who continue to grow should get this procedure. By the time your child stops growing, both limbs should become the same length.
Normally, surgeons conduct growth surgery when a child is between the ages of 10 and 14. It also depends on the differences in limb length. Epiphysiodesis works well for very few limb differences. Doctors consider this procedure a relatively simple, one-day procedure. After the procedure, your child can put his or her full weight on the leg almost immediately, and he or she will not require a cast but will need crutches for about a week or two. Regular follow-up appointments and X-rays should occur to monitor the success of the operation.
Hemiepiphysiodesis
This process pertains to straightening a deformed or crooked bone as a child grows. During a procedure, the doctor attaches a small metal plate to the growth plate at the end of the deformed bone. This slows down the growth of one side of the bone, allowing the other side to grow faster — straightening the limb.
The procedure occurs as an outpatient, and your child will not feel the metal plate because only an X-ray will reveal its presence. Regular follow-up appointments and x-rays are scheduled to allow the surgeon to keep tabs on the crooked limb and the straightening over time. Usually, complete straightening takes about 6 to 12 months, and once the bone straightens completely, the small metal plate gets removed to prevent curving in the other direction. This process does not work on all limb deformities, and therefore, our doctors will thoroughly examine the patient to determine eligibility.
Acute Deformity Correction
Reconstruction surgery can correct some limb deformities. In addition, this procedure fixes the deformity in a single surgery without requiring gradual correction. When your child is aroused from anesthesia, the limb is already straightened.
With this option, the surgeon divides the bone and then holds it together in the right place using metal plates, screws, or rods. After surgery, your child will need to refrain from putting weight on the operated limb and stop any lifting of heavy things. Additionally, your child will also need crutches for about 6 to 12 weeks and participate in physical therapy. Note that this is a one-time surgery that does not require further procedures.
Limb Shortening
This procedure involves reducing the length of the longer limb. Doctors consider this procedure for patients with limb length differences of about 2 to 5 cm. This procedure helps people who have completely stopped growing or are near the end of growing. If the child does not qualify for epiphysiodesis and you do not want your child to undergo a limb lengthening or height growth operation, this procedure may provide positive results. The surgery removes a length of bone from the longer limb and uses a rod or metal plate to hold the bone together. This will make both legs equal.
What to Expect During Limb Shortening Surgery
The surgery itself is carefully planned. The surgeon makes a precise cut in the bone of the longer limb, making sure to preserve blood flow and the body’s natural healing processes. After removing the necessary segment of bone, the ends are brought together and stabilized with a rod, plate, or screws, much like putting together the pieces of a puzzle and holding them firmly in place.
Your child will typically stay in the hospital for at least one night following the procedure. This allows for close monitoring as the initial healing begins. After a short period of rest—usually a week to 10 days—your child will start gentle movement, and physical therapy may help restore strength and mobility.
As with any bone surgery, parents should schedule follow-up appointments to ensure the bone is healing correctly and the limbs remain equal in length. It’s important to note that while this surgery can provide excellent results for certain patients, it may not work for all cases. Our doctors will take the time to explain all the options, so you can make the best decision for your child’s long-term health and comfort.
Who Is a Candidate for Limb Shortening?
Several factors help determine whether limb shortening is the right choice for your child:
- Limb stability: The joints at each end of the bone need stability to avoid joint problems after surgery.
- Overall tissue health: Healthy surrounding tissues are important. If trauma or significant scarring previously occurred, shortening may not work.
- Degree of limb length discrepancy: A difference of less than a centimeter usually doesn’t affect posture or function. Shoe lifts may help with differences up to two or two-and-a-half centimeters. Limb shortening is generally considered only when the difference impacts your child’s daily activities.
- Age and growth stage: This surgery is typically recommended for children who have finished growing, or are close to it.
- Commitment to recovery: Recovery from limb shortening requires dedication to physical therapy and follow-up care to ensure the best possible outcome.
As with any surgery, our doctors will thoroughly evaluate your child’s unique situation and discuss all possible options before moving forward. The surgery removes a length of bone from the longer limb and uses a rod or metal plate to hold the bone together. This will make both legs equal.
Although this surgery appears as the perfect solution for certain limb discrepancies, it could come with specific issues. Our doctors will fully explain the pros and cons of the procedure. With this operation, physical therapy must take place. It could take a year or more for the shortened limb to regain its former strength.
Is Your Child a Candidate for Limb Shortening?
Before moving forward, our team carefully considers several important factors to ensure this procedure is the right fit for your child:
- Joint and limb stability: The joints above and below the area to be shortened must be healthy and stable. If there is any instability, surgery could cause additional joint problems.
- Tissue health: Healthy surrounding tissues are crucial. If the area has significant scarring, perhaps from past injuries or surgeries, there is an increased risk for complications.
- Degree of limb-length difference: Small differences (about a centimeter or less) usually don’t disrupt posture or daily function. Shoe lifts or inserts can help with discrepancies up to 2–2.5 centimeters. Limb shortening is generally reserved for more significant differences that affect your child’s movement and activities.
- Age and growth stage: This procedure is most appropriate for children who are nearly finished growing or have completely stopped growing. It’s not recommended for younger children with significant growth remaining.
- Commitment to recovery: Limb shortening is not a quick fix. Your child—and your family—must know that it will take an extended period of healing and rehabilitation, including diligent physical therapy to restore strength and function.
Our specialists will thoroughly examine your child, review their medical history, and discuss the expected outcomes and potential risks. We want you to feel confident and informed every step of the way.
Highly Rated Limb Lengthening Doctors
Medical City Children’s Orthopedics and Spine Specialists comprises only board-certified and fellowship-trained orthopedic surgeons. With successful limb lengthening for children and height growth operations (specifically for children), we are the right doctors to take care of your child and all their limb needs.
Our team’s expertise extends beyond just the surgeons—you’ll also find dedicated physician assistants, nurse practitioners, and physical and occupational therapists who specialize in limb-length differences. We understand that childhood growth patterns can significantly influence the limb lengthening process, and our specialists are committed to tailoring every treatment to maximize limb function now and as your child grows.
Because limb lengthening and reconstruction procedures can be complex and come with important considerations, our approach is always thoughtful and patient-centered. We know that every child and family is unique, so we take the time to ensure you fully understand all your treatment options. From early childhood through early adulthood, we’re here to guide, support, and care for your child every step of the way.
The hospital takes pride in providing the very best care available for your child.
Patient Reviews
When you read the patient reviews of the Medical City Children’s Orthopedics and Spine Specialists, you will learn how much trust the parents have in our doctors. When choosing a doctor to help with unique procedures, parents should read all the reviews. Then discover what previous patients think of our expertise. Our parents and patients love us for a reason, and you will too.
Top-Notch Facilities and Equipment
Our doctor will operate on your child at the Medical City Hospital. Finally, Medical City Hospital provides the best care available. We take pride in keeping up to date with new and improved equipment to ensure success for each procedure.
Our Limb Lengthening Specialists Are Here for You
Our pediatric orthopedic Doctors, Shyam Kishan, Richard Hostin, and Kathryn Wiesman, have spent years studying children’s health and have devoted their lives to treating them. They are committed to providing children with arm or leg length discrepancies with a customized treatment plan. We utilize cutting-edge techniques and proven procedures to achieve positive outcomes for improved health. We also employ various surgical techniques to treat conditions affecting different limbs. Apart from routine limb lengthening, our pediatric orthopedic specialists treat joint contractures and other complications that cause limb length differences.
The Medical City Children’s Orthopedics and Spine Specialists doctors only treat children. Our doctors at Medical City Children’s Orthopedics and Spine Specialists are located in five convenient locations: Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, for families in the Dallas and Fort Worth area. Selecting a pediatric orthopedic doctor for your child is a crucial decision that requires careful consideration.
In conclusion, contact us today to learn more about your child’s arm or leg-lengthening procedure. Call 214-556-0590 for an appointment.
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National Institute of Health: Limb Lengthening