Leg Length Discrepancy in Patients With Lower Extremity Cutis Marmorata Telangiectatica Congenita: A Multicenter Retrospective Study

OBJECTIVES: To assess the frequency of leg length discrepancy (LLD) in patients with lower extremity cutis marmorata telangiectatica congenita (CMTC), describe associated findings, and characterize LLD management. METHODS: We conducted a retrospective chart review of patients diagnosed with lower extremity CMTC by dermatology and evaluated by orthopedics at Boston Children's Hospital and Children's Hospital of Philadelphia from 1997 to 2024. LLD was assessed by orthopedic examination and/or radiographic imaging. Major LLD was defined as ≥ 2 cm at any age, or between 1 and 2 cm in children 4 years old or younger. Mild LLD was defined as < 2 cm, except when ≥ 1 cm was present by age 4. Kaplan-Meier analysis estimated the probability of developing major LLD by age 15. RESULTS: Twenty-eight patients with lower extremity CMTC were included. LLD was identified in 12 of 28 patients (43%), including 8 confirmed radiographically and 4 diagnosed by clinical assessment alone. Two (7%) were classified as major and 10 (36%) as mild. Limb hypoplasia occurred in 18 of 28 patients (64%). Kaplan-Meier analysis estimated a 7.1% cumulative risk of major LLD by age 15. Three of 12 patients (25%) with LLD were prescribed shoe lifts. CONCLUSION: LLD is common among patients with lower extremity CMTC. Early orthopedic assessment may facilitate timely intervention.