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Leg Length Discrepancy - Coggle Diagram

- - - - It’s a physical (osseous) shortening of one lower limb between the trochanter femoral major and the ankle mortise. Congenital conditions include mild developmental abnormalities found at birth or childhood, whereas acquired conditions include trauma, fractures, orthopedic degenerative diseases and surgical disorders such as joint replacement. A systemic review evaluating the prevalence of LLD by radiographic measurements revealed that 90% of the normal population had some type of variance in bony leg length, with 20% exhibiting a difference of >9 mm
    - - It is a unilateral asymmetry of the lower extremity without any shortening of the osseous components of the lower limb. FLLD may be caused by an alteration of lower limb mechanics, such as joint contracture, static or dynamic mechanical axis malalignment, muscle weakness or shortening. It is impossible to detect these faulty mechanics using a non-functional evaluation, such as radiography. FLLD can develop due to an abnormal motion of the hip, knee, ankle or foot in any of the three planes of motion.
- - - - Idiopathic developmental abnormalities
      - Fracture
      - Trauma to the epiphyseal endplate prior to skeletal maturity
      - Degenerative disorders
        
        Legg-Calvé- Perthes Disease
      - Cancer or neoplastic changes
      - Infections
  - - - Shortening of soft tissues
      - Joint contractures
      - Ligamentous laxity
      - Axial malalignments
      - Foot biomechanics (such as excessive ankle pronation)
- - - - Gait asymmetries throughout the kinetic chain
      - Increased vertical displacement of the centre of mass resulting in increased energy consumption. Compensatory mechanisms for this includes: calcaneal eversion: knee extension:toe walking: circumduction: hip or knee flexion (steppage gait)
      - Decreased stance time and stride length in the shorter leg
      - Decreased walking velocity, increased walking cadence
- - - - Always use the mean of at least 2 or 3 measures
      - If possible, compare measures between 2 or more clinicians
      - Iliac asymmetries may mask or accentuate a limb length inequality
      - Unilateral deviations in the long axis of the lower limb (eg. Genu varum,…) may mask or accentuate a limb length inequality
      - Asymmetrical position of the umbilicus
      - Joint contractures
    - - Patient is standing with feet 10 cm apart, knees extended and equal weight on both feet. The clinician places his/her hands on a bilateral anatomical structure: spina iliaca posterior superior, spina iliaca anterior superior or crista iliaca left and right. Now the clinician visually assesses if there is a length inequality, and if so, places a wooden board of 0,5 cm under the foot of the shorter side. Keep placing thicker planks under the shorter side until equal length is reached, the thickness of the plank is equal to the leg length difference.
- - - - Consist in stopping the bone growth (in the longest leg) in adolescents and children.
      - Sometimes, in patients with skeletal maturity, limb shortening by bone resection procedures is sometimes performed.
      - Limb lengthening is generally reserved for LLI greater than 40-50mm. It involves corical osteotomy followed by the extremity being fitted with an external fixation device that applies continuous longitudinal distraction across the osteotomy site
  - - - Shoe Lifts: Shoe lifts can reduce low back pain, if patients’ low back pain is correlated to the LLD.
      - Heel Lift
      - Heel Lift with Foot Orthotic
      - Heel/sole Lift