Even though the importance of leg length discrepancy (LLD), with its potential of causing several pathological conditions or gait deviations, is well known, measuring LLD is still challenging with limited reliability and validity.
OBJECTIVE:
To assess the capability of the dynamic leg length (DLL) measurement in detecting the presence of anatomic LLD.
METHODS:
A lower limb x-ray was performed on 15 participants with suspected LLD in addition to a gait analysis study using a motion analysis system to measure DLL (the absolute distance from the hip joint centre to the heel, to the ankle joint centre and to the forefoot). Average DLLs were compared between sides for symmetry by the paired -test at 51 sample points during the gait cycle in conjunction with the differences between the sides based on the maximal stance phase and minimal swing phase DLLs. Differences were correlated with anatomic LLD by Pearson correlation.
RESULTS:
No significant differences in DLLs between sides throughout the gait cycle were found. Significant differences between sides were found between the maximal stance and minimal swing phase DLLs.
CONCLUSIONS:
DLL measurement is capable of detecting an anatomic leg length difference based on functional changes in leg length and functional discrepancy.
WalshMConnollyPJenkinsonAO’BrienT. Leg length discrepancy-an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture. 2000; 12(2): 156–61.
KnutsonGA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: Prevalence, magnitude, effects and clinical significance. Chiropr Osteopat. 2005; 13: 11. doi: 10.1186/1746-1340-13-11.
4.
IversenMDChudasamaNLosinaEKatzJN. Influence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther. 2011; 34: 148–152. doi: 10.1519/JPT.0b013e31820e16dc.
5.
SanhudoJAGomesJL. Association between leg length discrepancy and posterior tibial tendon dysfunction. Foot Ankle Spec. 2014; 7(2): 119–26. doi: 10.1177/1938640014522096.
6.
MahmoodSHuffmanLKHarrisJG. Limb-length discrepancy as a cause of plantar fasciitis. J Am Podiat Med Assoc. 2010; 100(6): 452–5.
7.
VinkPHusonA. Lumbar back muscle activity during walking with a leg inequality. Acta Morphol Neerl Scand. 1987; 25(4): 261–71.
8.
DefrinRBen BenyaminSAldubiRDPickCG. Conservative correction of leg-length discrepancies of 10 mm or less for the relief of chronic low back pain. Arch Phys Med Rehabil. 2005; 86(11): 2075–80. doi: 10.1016/j.apmr.2005.06.012.
9.
RaczkowskiJWDaniszewskaBZolynskiK. Functional scoliosis caused by leg length discrepancy. Arch Med Sci. 2010; 6(3): 393–8. doi: 10.5114/aoms.2010.14262.
10.
HarveyWFYangMCookeTDSegalNALaneNLewisCE, et al. Association of leg-length inequality with knee osteoarthritis: A cohort study. Ann Intern Med. 2010; 152(2): 287–95. doi: 10.7326/0003-4819-152-5-201003020-00006.
11.
FujimakiHInabaYKobayashiNTezukaTHirataYSaitoT. Leg length discrepancy and lower limb alignment after total hip arthroplasty in unilateral hip osteoarthritis patients. J Orthop Sci. 2013; 18(6): 969–76. doi: 10.1007/s00776-013-0457-3.
ResendeRAKirkwoodRNDeluzioKJCabralSFonsecaST. Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait. Gait Posture. 2016; 46: 147–153. doi: 10.1016/j.gaitpost.2016.03.012.
14.
ResendeRAKirkwoodRNDeluzioKJMortonAMFonsecaST. Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait. Clin Biomech. 2016; 38: 1–7. doi: 10.1016/j.clinbiomech.2016.08.001.
15.
EekMNZugnerRStefansdottirITranbergR. Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole. Gait Posture. 2017; 55: 150–6. doi: 10.1016/j.gaitpost.2017.04.022.
16.
KhamisSCarmeliE. Relationship and significance of gait deviations associated with limb length discrepancy: A systematic review. Gait Posture. 2017; 57: 115–23. doi: 10.1016/j.gaitpost.2017.05.028.
17.
KhamisSCarmeliE. The effect of simulated leg length discrepancy on lower limb biomechanics during gait. Gait Posture. 2017; 61: 73–80. doi: 10.1016/j.gaitpost.2017.12.024.
18.
WoermanALBinder-MacleodSA. Leg length discrepancy assessment: Accuracv and precision in five clinical methods of evaluation*. J Orthop Sports Phys Ther. 1984; 5: 230–9. doi: 10.2519/jospt.1984.5.5.230.
19.
AaronAWeinsteinDThickmanDEilertR. Comparison of orthoroentgenography and computed tomography in the measurement of limb-length discrepancy. J Bone Joint Surg Am. 1992; 74: 897–902.
20.
SongKMHallidaySELittleDG. The effect of limb-length discrepancy on gait. J Bone Joint Surg Am. 1997; 79(11): 1690–8. doi: 10.2106/00004623-199711000-00011.
21.
KhamisSCarmeliE. A new concept for measuring leg length discrepancy. J Orthop. 2017; 14: 276–80. doi: 10.1016/j.jor.2017.03.008.
22.
KhamisSDaninoBHayekSCarmeliE. Measuring clearance mechanics based on dynamic leg length. Meas Phys Educ Exerc Sci. 2017: 1–9. doi: 10.1080/1091367X.2017.1402020.
23.
SegevEHemoYWientroubSDrorOMichaelF, et al. Intra- and interobserver reliability analysis of digital radiographic measurements for pediatric orthopedic parameters using a novel PACS integrated computer software program. J Child Orthop. 2010; 4: 331–41. doi: 10.1007/s11832-010-0259-5.
24.
KadabaMPRamakrishnanHKWoottenME. Measurement of lower extremity kinematics during level walking. J Orthop Res. 1990; 8(3): 383–92. doi: 10.1002/jor.1100080310.
25.
WerveyRSM. A new device for improving foot marker alignment. In: Proceedings of the 8th Annual GCMAS Meeting, 2003.
26.
NaqviUShermanA. Muscle Strength Grading. Treasure Island, FL: StatPearls Publishing; 2017.
27.
DavisRBOunpuuSTyburskiDGageJR. A gait analysis data collection and reduction technique. Hum Mov Sci. 1991; 10: 575–87. doi: 10.1016/0167-9457(91)90046-Z.
28.
KhamisSDaninoBOvadiaDCarmeliE. Correlation between gait asymmetry and leg length discrepancy – what is the role of clinical abnormalities? Appl. Sci. 2018; 8(10): 1979. doi: 10.3390/app8101979.
