Coxa Vara/Valga & Leg Length Discrepancy

Question 1

Coxa Valga

Answer 1

Femoral neck shaft angle greater than 135 degrees (>135)

Question 2

Coxa Vara

Answer 2

Femoral neck shaft angle less than 120 degrees (<120)

Question 3

Coxa Vara/Valga Clinical Presentation

Answer 3

• Abnormal, painless gait pattern
• Trendelenburg limp
• Femoral retroversion or decreased anteversion
• Coxa vara — limb length discrepancy, prominent greater trochanter, and limitation of hip abd & IR

Question 4

Anatomical Leg Length Discrepancy

Answer 4

• Structural limb length inequality
• Physical shortening of one lower limb
• Congenital conditions, developmental abnormalities, and acquired conditions like trauma, fractures, degenerative diseases, and surgical disorders

Question 5

Anatomical/Structural Leg Length Discrepancy Causes

Answer 5

• Idiopathic developmental abnormalities
• Fracture
• Trauma to epiphyseal endplate prior to skeletal maturity
• Degenerative disorders
• Legg-Calve-Perthes
• Cancer
• Infections

Question 6

Functional Leg Length Discrepancy

Answer 6

• Non-structural shortening
• Unilateral symmetry
• Alteration of lower limb mechanics such as joint contracture or muscle weakness

Question 7

Functional Leg Length Discrepancy Causes

Answer 7

• Joint contractures
• Ligamentous laxity
• Axial malalignment
• Foot biomechanics (excessive ankle pronation)
• Shortening of soft tissues

Question 8

Leg Length Discrepancy Gait Issues

Answer 8

• Decreased stance time and stride length in shorter leg
• Decreased walking velocity
• Increased walking cadence
• Compensations — circumduction, toe walking, steppage gait (hip or knee flexion), knee extension, or calcaneal eversion

Question 9

Leg Length Discrepancy PT Management

Answer 9

• Stretching and strengthening
• Shoe lift
• Stretching — TFL, adductors, hamstring, piriformis, and iliopsoas