What We Treat

A lower limb difference is a leg that is missing, crooked, bowed, shortened, or a combination of these. There are many different reasons that could cause a lower limb difference.

Sometimes a child is born with a lower limb difference. This is called a congenital difference. Examples of congenital lower limb differences include:

Some lower limb deformities are associated with another condition. For example, children who are born with dwarfisms, such as achondroplasia, are often bowlegged.

A lower limb deformity can also be acquired, which means it develops over time. Some of the most common acquired lower limb deformities are caused by fractures or infections.

An underlying problem with the bone can also cause deformities. Children with rickets can have deformities because they have weak bones due to a lack of calcium and phosphate. Over time, the weak bones can bend. Similarly, lower limb deformities associated with multiple fractures can be caused by osteogenesis imperfecta (known as "brittle bone disease").

Limb deformities may be centered around certain joints, or can be due to various conditions.

Services We Offer

Prognosis and treatment for a lower limb difference depends on which limb is smaller and the size difference. No matter how big or small the limb difference may be, the goal is always to maximize function. 

Surgical options

Limb lengthening 
Limb lengthening is a treatment for major limb length discrepancies (often greater than two inches). In general, lengthening can be done with either an external fixator, or with an internal fixator.

While your child is undergoing lengthening treatment, the doctor will typically see you on a weekly basis to ensure the limbs are lengthening properly. In addition, physical therapy is very important during the lengthening process, as it can help prevent stiffness once the limb becomes longer.

Limb lengthening is a very specialized surgical skill, and only surgeons who are trained in limb lengthening should perform the operation. If the bone is lengthened too fast, it may not heal, and the surrounding muscles, nerves, and joints may be at risk for permanent damage. If the bone is lengthened too slow, it may heal too quickly, and the bone may not be able to reach its desired length.

There are two types of devices that are used in limb lengthening surgery:

It is important to have a thorough discussion with your surgeon about limb lengthening and which device is best suited for your child’s condition.

Learn more about limb lengthening

Other surgical options:

  • Lengthen or shorten smaller bones
  • Straighten bones 
  • Amputation
  • Reposition bones 
  • Transfer toes
  • Targeted muscle innervation
  • Orthotic devices—Custom fit braces and splints

We offer services for children who require various treatments:

  • Rehabilitation: The rehabilitation team at Children’s is trained and experienced in working with children who are undergoing limb-lengthening, limb-salvaging procedures or prosthetic training.
  • Prosthetics design: Our orthotics and prosthetics team provides some of the most advanced technology available in designing and fitting prostheses, including myoelectric and conventional prostheses for upper and lower extremities.
  • Silicone restoration: Provides patients who have a partial or complete loss of an extremity—hands, feet, fingers or toes—with a unique and realistic replacement prosthesis. The silicone can be sculpted and painted to match each patient’s size and skin tone, including details like wrinkles, veins and freckles. Silicone skins can be made to go over prostheses, including below-knee or above-knee leg prostheses. As the child grows, the silicone prostheses can be resized for a consistent appearance.
  • Adaptive Sports Program: Our team partners with sports medicine and rehabilitation to help children and teens find sports they enjoy and can play safely. We can design and assist with the technology needed for adaptive sports.

Our Unique Approach

When your child is missing all or part of an arm, leg, hand or foot—from birth or as the result of trauma—it affects your entire family. All of our team members are trained and experienced in working with children with limb differences and their families. We work closely with patients to make sure they have the training and support needed to be independent and confident, now and into the future.

Our surgeons have received additional limb lengthening training, and remain active in the limb lengthening and deformity communities. This helps ensure that your child receives the most up-to-date and informed treatment possible. Many of the Limb Deficiency Program surgeons are also members of ACPOC (Association of Children's Prosthetic-Orthotic Clinics) and LLRS (Limb Lengthening and Reconstruction Society).

The Children’s Limb Deficiency Program’s expertise goes beyond the surgeons. It also involves working with our pediatric physical therapists and orthotists to help ensure that your child’s limbs remain as functional as possible.

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