Differences between limbs aren’t uncommon as you’re growing. One arm may be slightly longer than the other. One leg may be a few millimeters shorter than the other.
From time to time, however, pairs of bones may have a significant difference in length. In arms, it may not be problematic. But in legs, it can lead to difficulty with movement, and eventually pain.
That’s when some people begin to consider bone-shortening surgery. While not the first option for treating uneven bones, bone-shortening surgery can help correct limb length differences, making a person more comfortable.
This article looks into why limb length differences occur and how bone-shortening surgery may help treat it.
There’s no such procedure as a height reduction surgery. A bone-shortening surgery may reduce your height, but they’re rarely done for this purpose.
Instead, these surgeries are more commonly performed to eliminate leg length difference or correct bones that are unevenly long.
Bone-shortening surgeries are most frequently used to treat a limb length discrepancy (LLD).
An LLD is a significant difference between the lengths of limbs. It may be as much as several centimeters or inches, and it’s likely most noticeable in legs.
For several months or even years, a person with an LLD may be able to compensate for the differences in their limbs. However, over time, LLD can lead to side effects and complications, like pain and difficulty walking or running.
Bone-shortening surgeries are designed to reduce the differences in limb lengths. Surgeries on leg bones are most common. In rare instances, surgery may be performed on arms that are a significantly different length.
In the case of legs, the surgery will likely reduce the person’s final height by a few centimeters.
Bone-lengthening surgeries can be used to add length to a shorter bone. This also helps eliminate uneven limb lengths, but it won’t reduce overall height.
Two types of surgery may be used to reduce a leg bone’s length. Which your surgeon may recommend depends on your age and the outcome your looking to reach.
Epiphysiodesis
Epiphysiodesis is essentially surgical destruction of the growth plates at the end of bones. With age, these growth plates produce bone material that hardens.
During this procedure, a surgeon scrapes or drills holes in the growth plates to prevent them from expanding or to slow them down. The surgeon may also put a metal plate around the growth plates to prevent additional bone development.
Limb-shortening surgery
The second procedure is called a limb-shortening surgery. As the name suggests, this surgery actually shortens the length of a bone, possibly affecting your overall height.
To do this, a surgeon removes a portion of the femur (thighbone) or tibia (shinbone). Then, they use metal plates, screws, or rods to hold the remaining pieces of bone together until they heal.
Healing may take several weeks and require you to have very limited movement. In fact, you may be in a full-length leg cast for weeks until your doctor is satisfied that the bone has healed properly.
The maximum length a surgeon can remove from the femur is about
The two procedures described above are intended for different groups of people.
Candidates for an epiphysiodesis
An epiphysiodesis is more frequently used for children and teenagers who are still growing.
This surgery must be timed precisely so that the bone that’s not impaired by surgery will be able to catch up to (but not surpass) the length of the other bone.
Candidates for bone-shortening surgery
A bone-shortening surgery is often best for young adults and adults who are finished growing. Most people are at their final height by age 18 to 20.
It’s only when you’ve reached this full height that a doctor has the best understanding of how much bone should be removed to even out any limb length differences.
Bone-shortening surgeries aren’t without risk. With an epiphysiodesis, potential side effects or complications include:
- infection
- bleeding
- deformity of bone growth
- continued growth of bones
- over- or under-correction that doesn’t eliminate the difference
Potential risks or side effects of bone-shortening surgery include:
- bones that heal out of alignment
- infection
- bleeding
- over- or under-correction
- nonunion, or bones that fail to properly join during healing
- pain
- loss of function
A difference in a child’s leg length may first become noticeable to parents as a child begins to walk. A routine screening at school for scoliosis (curvature of the spine) may also pick up a discrepancy in leg length.
To diagnose a variation in leg lengths, a doctor first reviews a child’s general health and medical history.
They then conduct a physical exam that involves observing the way a child walks. A child may compensate for a difference in leg length by walking on the toes of their shorter leg or bending the knee of their longer leg.
The doctor may measure the difference between legs by placing wooden blocks under the shorter leg until both hips are level. Imaging studies (such as X-rays and CT scans) may also be used to measure the length and density of the leg bones.
If a child is still growing, their doctor may recommend waiting to see if the difference in leg length increases or remains the same.
To monitor growth, the doctor may choose to repeat the physical examination and imaging tests every 6 to 12 months.
Both of these procedures are likely to cost several tens of thousands of dollars. Both will require a hospital stay, but a bone-shortening surgery may require an even longer stay. This increases the total cost of the procedure.
Insurance may cover the cost of either procedure, especially if your doctor determines the bone length differences is causing significant impairment.
However, it’s advisable that you call your health insurance company to verify coverage before undertaking the procedure so you don’t have any surprise bills.
If you’re unhappy with your height or have issues because your legs are different lengths, you should talk with a doctor.
In some cases, a correction may be as simple as wearing special shoes. Shoes with interior lifts can correct a limb length difference and help eliminate any issues it’s causing you.
But if the difference between your limbs is still too great, surgery may be an option. Your doctor can walk you through the steps that are necessary to determine if you qualify for surgery and help you prepare for the recovery process.
The human body isn’t symmetrical, so it’s not uncommon for a person to have slight differences in the length of their arms or legs. But greater differences — ones that are more than a few centimeters — can affect your well-being and quality of life.
If a limb length difference is causing you pain or affecting your day-to-day activities, a bone-shortening surgery may provide relief. Your doctor can help you begin the process to understand your options.