Short Stature

What short stature is

Short stature is a description, not a diagnosis in itself. It can be a normal variant, as in a person who is simply shorter than average and healthy in every other respect, and it can also be a feature of an underlying condition. Growth is one of the indicators clinicians use to follow a child's health, which is why a growth pattern that departs from expectation is usually looked into rather than assumed to be either benign or serious.

A distinction that matters orthopedically is between proportionate and disproportionate short stature. In the proportionate pattern the body is smaller overall but the parts keep their usual relationship to one another. In the disproportionate pattern that relationship differs, most often with limbs short relative to the trunk, and skeletal conditions such as achondroplasia are among the causes. Across both groups the causes are wide ranging, including familial short stature, nutritional factors, hormone deficiencies, chronic illness and genetic conditions. Orthopedic care enters where the skeleton itself is involved: limb proportion, angular deformity of the legs, spine alignment, joint mechanics and, in selected situations, limb lengthening.

Reasons people seek an orthopedic opinion

• Limbs that appear short relative to the trunk, or arm span that does not match height
• Bowing or other angular deformity of the legs
• A growth pattern a pediatrician wishes to have assessed skeletally
• Joint or back pain thought to relate to skeletal proportion or alignment
• A wish to understand whether limb lengthening or deformity correction is an option

How it is evaluated

Assessment usually begins outside orthopedics, with growth measurements recorded over time, family history, and testing arranged by a pediatrician or endocrinologist to look for hormonal, nutritional, genetic or systemic causes. The orthopedic part examines the skeleton: measurement of the limb segments and trunk, alignment of the legs, examination of the hips, knees and spine, and imaging of the areas involved. X-rays show the shape and proportion of the bones and, in a child, give information about remaining growth. The purpose is to understand what is driving the pattern before any discussion of intervention.

Treatment options in general terms

For many people with short stature, no orthopedic treatment is needed. Where care is provided, it is directed at specific problems rather than at height as such.

• Monitoring. Following alignment, joint function and, in children, growth over time, so changes are identified as they develop.
• Medical care through other specialties. Where an endocrine, nutritional or systemic cause is identified, treatment is directed by the physicians managing it.
• Supportive measures. Physical therapy, activity guidance, footwear and adaptive strategies may be discussed for specific difficulties.

Surgical options exist and are individualized, and the decision to consider them involves the patient and family at length.

• Deformity correction. Angular or rotational deformity of the limbs may be corrected surgically, either at one operation or gradually with an external frame.
• Limb lengthening. A bone can be divided and then separated in very small daily increments, so new bone forms in the widening gap. Using the Ilizarov method this can be carried out in children and adults, with alignment addressed in the same treatment.

What to expect when you consult Dr. Wolfson

Dr. Wolfson trained in the Ilizarov method of limb lengthening, reconstruction and deformity correction, and evaluates patients with disproportionate limb length and limb deformity. A consultation is a discussion as much as an examination: what the measurements and imaging show, and what an orthopedic option would and would not change. Nothing is decided in a single visit, and care is coordinated with the specialists already involved. Our page on leg length discrepancy covers differences between the two limbs specifically.

This page provides general information about short stature and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]