Short Leg syndrome

Question 1

short leg syndrome- causes

Answer 1

• anatomical
• functional
• coronal- short leg
• sagittal- pelvic tilt

Question 2

structural etiologies

Answer 2

• fractures- foot, ankle, tibia, femorus
• salter-harris fractures
• total hip arthroplasty
• total knee arthroplasty
• pes planus

Question 3

pes planus

Answer 3

(flat feet)

-overpronated, internally rotated hip compensation

Question 4

Talus

Answer 4

(latin for ankle)

-if pathology- rest of ankle must compensate

Question 5

early childhood fracture

Answer 5

• end of bone?
• growth problems?
• hem lines, cuff length problems?

Question 6

Salter Harris classification

Answer 6

(growth plate fractures)

• type 1 and II- growth plate unaffected
• III and IV- plate broken, may bridge
• V- crushed

Question 7

hip joint causes

Answer 7

Avascular necrosis
-age 4-10, painless limp, LEGG-CALVE-PERTHES dz
Slipped Capitol Femoral Epiphyses
-obese teenager, painful limp

Question 8

Functional causes

Answer 8

• innominate rotation

- LE, sacrum, thoracolumbar SD

Question 9

innominate rotation

Answer 9

-caused by ligament strain, muscular contraction (adductors, hip flexors, hamstrings)

Question 10

anterior innominate rotation

Answer 10

• longer leg

- higher iliac crest

Question 11

musculoskeletal effects of short leg syndrome

Answer 11

• gait- most efficient when center of gravity moves least (S2)
• postural changes

Question 12

result of proprioception

Answer 12

• eyes level w horizon

- sacrum level

Question 13

unlevel sacral base

Answer 13

• causes compensatory curves in spine

- to keep the eyes level w horizon!! (maintain sense of place and position)

Question 14

postural compensatory changes- early and late

Answer 14

• early- C-shape curve w convexity on side of short leg- shoulder on short leg more superior
• late- S-shape curve- shoulder on short leg side more inferior

Question 15

postural compensatory changes

Answer 15

• pelvis side shifts and rotates twd long leg side
• innominate on short leg side anterior rotates
• innominate on long leg side post rotates
• long leg side- foot is pronated, internally rotating the ipsilateral hip

Question 16

postural compensatory changes- LE m asmmetry

Answer 16

• tight hamstrings (long side)
• tight rectus femoris (short side)
• tight adductors (short side)

Question 17

iliolumbar ligament

Answer 17

-short leg side- tender point

Question 18

gold standard- dx

Answer 18

-standing pelvis radiograph

Question 19

tx

Answer 19

• level pelvis

- lift in shoe- start slowly!!

Question 20

helig formula

Answer 20

L = [SBU] / [D + C]

• L- lift required
• SBU= sacral base unleveling
• D= duration= 1 (0-10), 2 (10-30), 3 (30+ yrs)
• C= compensation= 0 (none), 1 (rotation of vertebrae into compensatory SB), 2 (wedging of vertebrae)

Question 21

lift therapy

Answer 21

• leg length discrepancy > 5 mm
• limit of 1/2 inch lift can go inside shoe
• if spine is flexible- begin w 1/8 inch left (inc every 2 wks)
• if fragile spine- begin w 1/16 in