Limb length discrepancy: When, how to intervene?

NewsBot · Aug 4, 2016

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From July LER:
Limb length discrepancy: When, how to intervene?

Admin2 · Aug 4, 2016

Related Topic:
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Compensating for leg length difference

NewsBot · Jun 1, 2017

Relationship and Significance of Gait Deviations Associated with Limb Length Discrepancy: A Literature Review
Sam Khamis et al
Gait and Posture; Article in Press

Controversy still exists as to the clinical significance of leg length discrepancy (LLD) in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and LLD. The objectives of our study were to review the available research with regard to LLD as a cause of clinically significant gait deviations, to determine if there is a relationship between the magnitude of LLD and the presence of gait deviations and to identify the most common gait deviations associated with LLD. In line with the PRISMA guidelines, a literature search was carried out throughout the Medline, CINAHL and EMBASE databases. Twelve articles met the predetermined inclusion criteria and were included in the review. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Two main methodologies were found in 4 studies evaluating gait asymmetry in patients or healthy participants with anatomic LLD and 8 studies evaluating gait deviations while simulating LLD by employing artificial lifts of 1–5 cm on healthy subjects. A significant relationship was found between anatomic LLD and gait deviation. Evidence suggests that gait deviations may occur with discrepancies of >1 cm, with greater impact seen as the discrepancy increases. Compensatory strategies were found to occur in both the shorter and longer limb, throughout the lower limb. As the discrepancy increases, more compensatory strategies occur. Sagittal plane deviations seem to be the most effective deviations, although, frontal plane compensations also occur in the pelvis, hip and foot.
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NewsBot · Jun 17, 2017

Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine
Kelvin J. Murray et al
The Journal of Manipulative and Physiological Therapeutics

Objective
The purpose of this study was to evaluate the correlation between mild leg length discrepancy (LLD) and degenerative joint disease (DJD) or osteoarthritis.

Methods
We evaluated standard postural lumbopelvic radiographs from 255 adults (121 women and 134 men) who had presented with spinal pain for chiropractic care. Symmetry of femoral head diameters was used to exclude magnification errors. Pearson’s partial correlation was used to control for age and derive effect sizes for LLD on DJD in the hip and lower lumbar motion segments. Krippendorff’s α was used for intraobserver and interobserver reliability.

Results
A strong correlation was found between LLD and hip DJD in men (r = 0.532) and women (r = 0.246). We also found a strong correlation between LLD and DJD at the L5-S1 motion segment in men (r = 0.395) and women (r = 0.246). At the L4-5 spinal level this correlation was much attenuated in men (r = 0.229) and women (r = 0.166).

Conclusions
These findings suggest an association between LLD and hip and lumbar DJD. Cause–effect relationships between mild LLD and DJD deserve to be properly evaluated in future longitudinal cohort studies.
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NewsBot · Dec 23, 2017

Functional leg length discrepancy between theories and reliable instrumental assessment: a study about newly invented NPoS system.
Mahmoud A et al
Muscles Ligaments Tendons J. 2017 Sep 18;7(2):293-305. doi: 10.11138/mltj/2017.7.2.293.

BACKGROUND:
In spite the instinct social&financial impact of Leg Length Discrepancy (LLD), controversial and conflicting results still exist regarding a reliable assessment/correction method. For proper management it's essential to discriminate between anatomical&functional Leg Length Discrepancy (FLLD). With the newly invented NPoS (New Postural Solution), under the umbrella of the collaboration of PRM Department, Tor Vergata University with Baro Postural Instruments srl, positive results were observed in both measuring& compensating the hemi-pelvic antero-medial rotation in FLLD through personalized bilateral heel raise using two NPoS components: Foot Image System (FIS) and Postural Optimizer System (POS). This led our research interest to test the validity of NPoS as a preliminary step before evaluating its implementations in postural disorders.

METHODS:
After clinical evaluation, 4 subjects with FLLD have been assessed by NPoS. Over a period of 2 months, every subject was evaluated 12 times by two different operators, 48 measurements in total, results have been verified in correlation to BTS GaitLab results.

RESULTS:
Intra-Operator&inter-operator variability analysis showed statistically insignificant differences, while inter-method variability between NPoS and BTS parameters expressed a linear correlation.

CONCLUSION:
Results suggest a significant validity of NPoS in assessment&correction of FLLD, with high degree of reproducibility with minimal operator dependency. This can be considered a base for promising clinical implications of NPoS as a reliable cost effective postural assessment/corrective tool.
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NewsBot · Aug 2, 2018

LEG-LENGTH INEQUALITY AND RUNNING-RELATED
INJURY AMONG HIGH SCHOOL RUNNERS
Mitchell J. Rauh
The International Journal of Sports Physical Therapy | Volume 13, Number 4 | August 2018 | Page 643

Background: Participation in high school cross-country continues to increase with over 492,000 participants during
the 2016-17 cross-country season. Several studies have indicated a high incidence of running-related injuries (RRI) in
high school cross-country runners. Risk factors for RRI can be divided between intrinsic and extrinsic risk factors.
Intrinsic risk factors such as structural asymmetries have received less attention in recent years.
Purpose: The primary purposes of the current study were to (1) describe the prevalence of leg-length inequality
among female and male high school cross-country runners, and (2) to determine whether leg-length inequality was
associated with increased RRI in female and male high school cross-country runners.
Study Design: Prospective observational cohort study.
Methods: Three hundred ninety-three (222 males, 171 females) athletes competing in high school cross-country running
were followed, prospectively. The runners’ right and left leg-lengths were measured with a standard cloth tape
measure in a supine position. Incidence of low back/lower extremity RRI during practices or competitive events was
monitored using the Daily Injury Report.
Results: A similar percentage of leg-length inequality greater than 0.5 cm was found among female (19.3%) and male
(22.1%) runners. No statistically significant associations were found between leg-length inequality and (RRI) for
female or male runners, with the exception that after adjusting for BMI, males with a leg-length inequality >1.5 cm
were over seven times more likely to incur a lower leg RRI (Adjusted Odds Ratio=7.47; 95%CI: 1.5, 36.9; p=0.01) than
males with a leg-length inequality <0.5 cm. Side of RRI was not associated with side of longer limb length.
Conclusions: While leg-length inequality was not associated with RRI, in general, males with a leg-length inequality
>1.5 cm were at greater likelihood of sustaining a lower leg RRI.
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NewsBot · May 14, 2019

Leg Length Discrepancy in College Students and
Its Association with Low Back Pain: a Preliminary
Study
Ignatio Rika Haryono et al
J. Anthr. Sport Phys. Educ. 3 (2019) 2

Leg length discrepancy (LLD) is a condition in which lower extremities have a diff erent length. The discrepancy can cause functional dysfunction and health problem. Low back pain (LBP) is one of a health problem
associated with LLD. The prevalence of LBP in young people increases over time. This study aimed to evaluate the association between LLD and LBP in college students. This cross-sectional study involved 75 (40
female) students of Faculty of Medicine, Atma Jaya. Height, weight, and BMI were measured and calculated. True leg length was measured three times using tape measurement in the supine position. The LLD
was defi ned as the diff erence of 10 mm or more. Numeric data between LLD vs no LLD were compared
using independent samples of the t-test. The association between LLD, LBP, and other variables were evaluated using chi-square. A p-value <0.05 was set as statistically signifi cant. Statistics analysis was computed using SPSS (ver. 17). Leg length discrepancy and LBP were found in 31 (22 female) and 36 (22 female),
respectively. Among those with LBP, 16 were LLD (44.4%). No association was found between LBP and LLD
(p=0.548), BMI (p=0.518), and gender (p=0.164). Gender was associated with LLD (OR 3.53, 95%CI 1.32 -
9.42, p=0.010). Only 5 (13.9%) of aff ected LBP experienced dysfunctional state. There is no relationship between LLD, gender, BMI and LBP in students of the Faculty of Medicine. Female have a higher risk of LLD.
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NewsBot · Jun 7, 2019

Leg Length Discrepancy: The Natural History (And What Do We Really Know).
Gordon JE, Davis LE
J Pediatr Orthop. 2019 Jul;39(Issue 6, Supplement 1 Suppl 1):S10-S13. doi

BACKGROUND:
The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies.

METHODS:
A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb length discrepancies. Papers reporting only expert opinion or case reports were excluded.

RESULTS:
Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb length discrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb length discrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis.

CONCLUSIONS:
There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.
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NewsBot · Feb 10, 2022

Effects of orthotic insole on gait patterns in children with mild leg length discrepancy
YuanyuanShia et al
Gait & Posture; 9 February 2022

Background
Leg length discrepancy (LLD) is commonly associated with compensatory gait strategies leading to musculoskeletal disorders of the lower extremity and lumbar spine. Orthotic insole (OI) is considered as a conservative treatment for patients with mild LLD, especially for children. However, the restoration of normal gait when wearing OI with foot lift are still poorly understood.

Research question
What are the immediate effects of OI on the gait patterns in children with mild LLD?

Methods
Gait data and plantar pressure data were collected for 12 children with mild anatomical LLD in barefoot and OI conditions. Paired t-test was performed to determine the changes in gait between these two conditions, and also the symmetry between limbs in the same condition for spatiotemporal, kinematic, and kinetic variables.

Results
Children with mild LLD showed an immediate gait improvement confirmed by increased step length and velocity, decreased peak plantar pressure in both limbs with OI. Additionally, the significant between-limb differences disappeared for peak ankle dorsiflexion, hip adduction, pelvis upward obliquity and also second peak plantar pressure with OI, which improved gait symmetry.

Significance
This study provides a better understanding of the immediate effect of OI with foot lift on biomechanical changes in gait, which identify that OI with foot lift could be a potential therapeutic option for children with mild structural LLD to improve gait metrics.
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