The condition refers to a leg-length inequity in which there is shortening of the bones of the lower extremity.

The causes of shortening of bones of the lower extremity may be either congenital or acquired. Acquired conditions include: injury associated with overuse; syndromes with the shorter leg usually being the injured leg; infection such as osteomyelitis and septic arthritis; neoplastic disorders, such as hemangioma; neuromuscular disorders, such as cerebral palsy and poliomyelitis; traumatic causes such as malunion; and other causes, such as reconstructive surgery for hip replacement. Inflammatory conditions like juvenile arthritis and hemophilia can cause growth stimulation in the affected limb due to joint inflammation adjacent to the epiphysis. Other traumatic causes include radiation or burns.

The signs and symptoms of the condition may include: limping, deterioration, swelling, and bruising. There may also be evidence of a fracture, such as localized tenderness and swelling of the tissue surrounding the area. There may be a discrepancy in the measurement taken of the lower extremities, from less than 1 inch to greater than 4 inches.

Tests may include: a complete history and physical examination, bone scan, and x-rays. Measurements are taken of both lower limbs from the anterior spine of the ilium to the internal malleolus of the tibia.

Treatment may include: restoration of length; use of orthotic devices such as elevated inner soles of the shoes; and elevated shoes.

Residuals may include the development of a walk anomaly, e.g., an abnormal walking cycle.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Measure both lower extremities from anterior superior spine of the ilium to the internal malleolus of the tibia. Not to be combined with other ratings for fracture or faulty union in the same extremity. 38 CFR 4.71 [Measurement of ankylosis and joint motion] and 38 CFR 4.71a [Schedule of ratings - musculoskeletal system].

• Entitled to special monthly compensation under 38 CFR 3.350. Also, consider entitlement to SMC as an issue in every case where there is a severe degree of disability involving the loss or loss of use of an extremity or sensory organ or any other functional loss providing entitlement to SMC. If SMC is not granted, the reason must be indicated.