Lld

Question 1

simply name the 3 categories of limb length discrepancies

Answer 1

1. structural:
2. functional
3. environmental

Question 2

when do we treat an LLD?

Answer 2

• when it is symptomatic
• when it is greater than 1-2cm (action needed to prevent future complications)
• must assess if treatment will cause more trouble than the presenting situation esp. in older population we need to implement rx. incrementally (watch arthritis/balance etc,)

Question 3

outline compensation that occurs for LLD

Answer 3

• may occur at any level
• STJ supinate on shorter side/pronate on longer side
• AJ will PF on shorter leg
• knee may flex, recurvatum varum/valgum of longer leg
  spine may: a) not compensate, b) lumbar and cervical scoliosis with tile of shoulder/head to long side, c) lumbar scoliosis with slight or no shoulder tilt on long side

Question 4

sequelae of LLD: name the areas that LLD can affect

Answer 4

hips, knees, back, foot. over a period of years the sequelae can lead to a variety of overuse injuries

Question 5

outline treatment of LLD

Answer 5

if structural:

• heel lifts if less than 1 cm
• full length lift or external raise
• orthotics with or without heel raise incorporated
• physiotherapy/chiropractic consultation esp if scoliotic involvement or back pain

Question 6

outline the method of diagnosis for LLD

Answer 6

look for asymmetrical symptoms e.g. shoewear, gait patterns, adjustments by patients to provide symptomatic relief

• differentiation must be made between structural and functional
• plain x-rays: standing in normal shoe wear = gold standard

Question 7

is shoulder tilt a good indicator of LLD? why/why not

Answer 7

nah its dumb! the spine may compensate by a) not compensating –> pelvis & shoulder drop on shorter side, b) lumbar and cervical scoliosis with tilt of shoulder/head to long side, c) lumbar scoliosis with slight or no shoulder tilt on long side

Question 8

describe the back pain component of LLD sequelae

Answer 8

scoliotic compensation causes compression of intervertebral discs which may cause herniation or OA

Question 9

describe the hip pain component of LLD sequelae

Answer 9

elevation of the pelvis may cause decrease in contact area of femur in acetabulum –> causing OA

Question 10

describe some of the lower limb compensation sequelae

Answer 10

• excessive STJ pronation causes lower extremity to internally rotate and drop inferiorly and leads to a narrowing of the greater sciatic notch thereby predisposing the entrapment of sciatic nerve
• the lumbar spine attempts to straighten itself by laterally flexing toward the long leg which compresses the lateral aspects of the discs on that side