Short Leg Syndrome

Question 1

Define short leg syndrome - coronal and saggital changes.

Answer 1

coronal - short leg

saggital - pelvic tilt

Question 2

What happens structurally to the feet in flat feet - pes planus

Answer 2

OVERPRONATED AND INTERNALLY ROTATED hip compensation

Question 3

Define the Salter Harris classification types.

Which would affect growth?

Answer 3

Type 1 and 2: growth plate unaffected
Type 3 and 4: plate broken, may bridge
Type 5: crushed injury resulting in bone to bone fusion

types 3, 4, 5 would affect growth

Question 4

What is the structural growth etiology of the hip joint in an obese teenager with a painful limp?

Answer 4

Slipped Capitol Femoral Epiphysis

Question 5

What is the structural growth etiology of the hip joint in a child age 4-10 with a painless limp? What can result?

Answer 5

LEGG – CALVE – PERTHES disease

Avascular necrosis can result

Question 6

Innominate rotation falsely lengthens or shortens legs. Name the possible causes of rotation:
-Ligament strain.
-Muscular Contraction:
 Adductors - attach from ___ to ___
 Hip Flexors - attach from ___ and ___ to ___ –> Tight hip flexors cause what rotation?
 Hamstrings - attach from ___ to ___ –> Tight hamstrings cause what rotation?

Answer 6

 Adductors – attach from pubic ramus to femur.
 Hip Flexors – attach from iliac fossa & lumbar spine to lesser trochanter of femur. Tight hip flexors cause ANTERIOR ROTATION LENGTHENS LEG.
 Hamstrings – attach from ischial tuberosity to tibia or fibula or both. Tight hamstrings cause POSTERIOR ROTATION SHORTENS LEG.

Question 7

If someone has an EXTERNAL ROTATION of the leg, you would expect that side to be taller or shorter?

Answer 7

shorter on the ER side

Question 8

If the pelvis were rotated anteriorly on the left, (ASIS anterior and inferior) would the leg
appear to be:
SHORTER or LONGER?

Answer 8

anterior rotation lengthens the leg

posterior rotation shortens the leg

Question 9

If the innominate were rotated anteriorly [saggital plane] on the right (like the past example) would the iliac crest on that side be:
Higher? Or Lower?

Answer 9

higher

Question 10

Where is the center of gravity around? What vertebral level?

Answer 10

center of gravity is about S2

Question 11

Name the evaluation of posture - what areas?

Answer 11

• External Auditory Meatus
• Tip of the Acromion
• Center of the body of 3rd Lumbar Vertebrae
• Through the center of the Knee
• Just anterior to lateral malleolus

Question 12

Why are there compensatory curves in the spine due to an unlevel sacral base?

Answer 12

To keep eyes level with the horizon and maintain sense of place and position.

Question 13

Is this an early or late postural compensatory change?

Spine tends toward a “C” shape curve with convexity on side of short leg. *Shoulder on short leg side more superior

Answer 13

EARLY

Everything SB away from short leg early on.

(short R leg = lumbar spine SB L –> COT to upper thoracics SB R to make “S shape”

Question 14

Is this an early or late postural compensatory change?

Spine’s compensatory mechanism distribute forces over several lateral curves. “S” shaped curve. *Shoulder on short leg side more inferior

Answer 14

LATE

Question 15

Postural Compensatory changes - Innominate on short leg side v. long leg side.

Answer 15

Short leg anteriorly rotates.

Long leg posteriorly rotates.

Question 16

Postural Compensatory changes - Pelvis side shifts and rotates around the transverse plane to the short or long side?

Answer 16

pelvis shifts toward long leg side

Question 17

Postural Compensatory changes - On long leg side the foot is pronated, causing what change?

Answer 17

internally rotating the ipsilateral hip

Question 18

Tight hamstrings (long side) on one thigh and tight rectus femoris (short leg) on opposite thigh.
What plane changes and short side has which muscle tightness?

Answer 18

 Pelvic transverse plane changes

 Short side - rectus femoris tight

Question 19

Tight abductor (long side) on one side with tight adductors (short leg) on opposite thigh.
What plane changes and short side has which muscle tightness?

Answer 19

 Pelvic coronal plane changes

 Short side - adductors tight

Question 20

***Iliolumbar ligament of lumbroacral convex/cavity? Not is painful on what side?

Answer 20

convexity - the SHORT leg side.

pain refers to hip and groin

(connects L4-L5 to ASIS)

Question 21

Gold standard for evaluation of leg length.

evaluate what three levels?

Answer 21

Standing radiograph to determine amount of sacral base unleveling.

evaluation iliac crest, sacral base, and femoral head levels.

Question 22

normal ferguson’s angle.

Answer 22

25-35 degrees

Question 23

What is the Heilig Formula?

Answer 23

L = [SBU] / [D+C]

L: Lift required

SBU: Sacral Base Unleveling (determine with the lines)

D: Duration of dysfunction
1= 0-10; 2 = 10-30; 3 = 30+ years

C: Compensation. 0 = none; 1 = rotation of vertebrae into compensatory sidebending; 2 = wedging of vertebrae

Question 24

When leg length discrepancy is greater than __mm go do lift therapy.

If spine is flexible with mild-moderate scoliosis, begin and increase how much?

If spine is fragile, begin and increase how much?

Answer 24

greater or equal to 5mm

1/8 inch and increase every 2 weeks
1/16 inch and increase every 2 weeks

Question 25

If you have a short R leg, what compensatory mechanisms?

Answer 25

Sacrum SB toward short, lumbar spine SB away, or possible thoracic SB toward.

Question 26

**What is the tender point that first develops with postural decompensation?

Answer 26

short leg side, over the Iliolumbar ligament