leg length discrepancy


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leg length discrepancy

Limb length discrepancy Orthopedics A difference in leg lengths, clinically significant at > 3 cm, affecting heart rate, muscle activity and O2 consumption Compensation strategies Steppage, circumduction, vaulting, hip hiking. See Gait analysis.

leg length discrepancy

difference in the true length of one leg compared to the other. It may be structural (secondary to a pre-existing condition such as Perthes' disease) or functional as a result of altered lower limb biomechanics. Differences of 0.5-1 cm are not uncommon and usually asymptomatic. Greater discrepancy will produce a compensatory pelvic tilt or secondary scoliosis (lateral curvature of the spine). This compensation, combined with repetitive exercise, can cause problems including discomfort in the back, lower limb (especially knee) pain or Achilles tendonitis. Treatment includes improving pelvic control and core stability and the use of orthoses. It is important to identify this problem to allow correct treatment, as treatment of the secondary effect alone will not alleviate the symptoms.

leg length discrepancy

; LLD true leg length inequality (i.e. >1 cm difference in adult), or apparently unequal length (secondary to e.g. spinal scoliosis or pelvic tilt, so that legs function as in LLD)
  • extrinsic compensation for LLD compensatory frontal-plane adjustment, e.g. pelvic tilt (higher anterior superior iliac spine on longer leg side), spinal scoliosis (convexity toward shorter leg), pectoral tilt (lower shoulder on side of longer leg + apparently longer arm on same side as longer leg)

  • intrinsic compensation for minor LLD longer leg shows e.g. excess foot pronation, internal knee/limb rotation, lack of knee extension; shorter leg shows supination (high arch), early heel lift and genu recurvatum

  • symptoms of LLD range of pathologies relating to gait unevenness and associated symptoms of strain, e.g. neck pain, sacroiliitis, osteitis pubis, psoasitis, quadriceps strain, pes anserinus bursitis, groin (adductor) strain, knee arthrosis, anterior knee pain, peroneal tendinitis, shin splints, Achilles tendinitis, sinus tarsi syndrome, metatarsalgia, intermetatarsal neuroma and sesamoiditis (Box 1)

  • treatment of marked LLD (i.e. >3 cm LLD, e.g. secondary to limb trauma, musculoskeletal or neurological disease) provision of orthoses and bespoke prosthetic shoe incorporating whole-foot shoe raise to accommodate equinus ankle deformity of short leg

    treatment of minor LLD (i.e. <1 cm LLD) heel rise to shorter leg

  • treatment of significant LLD (i.e. 1-2 cm LLD) full biomechanical assessment and provision of bespoke orthoses, plus full-length sole raise

Box 1: Effects of limb length discrepancy
  • Increased activity of the lumbar spinal musculature to control spinal scoliosis

  • Changes in the congruency in the lumbar vertebrae and alteration to the shape of the lumbar intervertebral discs

  • Asymmetrical pelvic rotation and spinal scoliosis

  • Unilateral hip arthritis (of the longer limb)

  • Shoulder tilt and with uneven arm swing, with apparent arm length discrepancy

  • Knee pathologies and vastus medialis strain on the longer limb

  • Excessive pronation of the subtalar and midtarsal joints of the longer limb

  • Functional ankle equinus of the shorter limb (early heel lift; reduced heel strike)

References in periodicals archive ?
Also, no significant correlation between LBP and leg length discrepancy, hamstring flexibility, active lumbar forward flexion, and isometric muscle endurance of trunk extensors was detected.
Limb shortening for the management of leg length discrepancy.
I recommend that we think of leg length discrepancy in any patient with nontraumatic hip pain and test for it in the exam room.
Preoperative assessment of patient with hip pain from the perspective of leg length discrepancy includes radiographic and clinical evaluation.
Minor leg length discrepancy (<2cm--shortening/lengthening) at final follow-up (24 weeks), 4.
The effect of leg length discrepancy on spinal motion during gait.
There are multiple alignment problems that can contribute to this including rotation of your femur, genu valgus or knock-knees, leg length discrepancy (either functional, when running on the same side of a cambered surface, or actual), excessive curvature of your back (lordosis), hip flexor tightness, hamstrings tightness, weak quadriceps, imbalance between hamstrings and quadriceps, or other biomechanical problems.
8-9) Predisposing factors includes trauma, excessive exercise, leg length discrepancy (altered biomechanics causes stretching and shortening of piriformis muscle), cerebral palsy and narrowed sciatic foramen etc.
The muscles of the lower leg were studied before, during, and after leg lengthening in 38 patients with achondroplasia and in 32 patients with congenital leg length discrepancy.
Make sure that a sports medicine professional evaluates your gait, your feet and running shoes, and considers leg length discrepancy.