The treatment of limb length inequality in pediatric patients is a complicated and long-term procedure, and careful evaluation is necessary over several visits. A team approach with an involved family is essential, as is knowledge and familiarity with the various conservative and surgical options. Treatment must not be rushed, and it is important to realize that not everyone needs a lengthening. Soft tissue and osseous complications are significant in these procedures, so shoe lifts and shortening procedures are attractive alternatives in smaller discrepancies. This condition is in a growing child and therefore not static. Future growth may dictate that procedures be staged. Most importantly, we must carefully equalize limb length in a manner that is neither physically nor emotionally scarring (Fig 26). These children are best served by a well-thought out plan that minimizes both kinds of trauma, decreases hospital and treatment time, and involves the family and patient in the planning and understanding of the proposed intervention and potential complications.