Short Leg syndrome Flashcards
short leg syndrome- causes
- anatomical
- functional
- coronal- short leg
- sagittal- pelvic tilt
structural etiologies
- fractures- foot, ankle, tibia, femorus
- salter-harris fractures
- total hip arthroplasty
- total knee arthroplasty
- pes planus
pes planus
(flat feet)
-overpronated, internally rotated hip compensation
Talus
(latin for ankle)
-if pathology- rest of ankle must compensate
early childhood fracture
- end of bone?
- growth problems?
- hem lines, cuff length problems?
Salter Harris classification
(growth plate fractures)
- type 1 and II- growth plate unaffected
- III and IV- plate broken, may bridge
- V- crushed
hip joint causes
Avascular necrosis
-age 4-10, painless limp, LEGG-CALVE-PERTHES dz
Slipped Capitol Femoral Epiphyses
-obese teenager, painful limp
Functional causes
- innominate rotation
- LE, sacrum, thoracolumbar SD
innominate rotation
-caused by ligament strain, muscular contraction (adductors, hip flexors, hamstrings)
anterior innominate rotation
- longer leg
- higher iliac crest
musculoskeletal effects of short leg syndrome
- gait- most efficient when center of gravity moves least (S2)
- postural changes
result of proprioception
- eyes level w horizon
- sacrum level
unlevel sacral base
- causes compensatory curves in spine
- to keep the eyes level w horizon!! (maintain sense of place and position)
postural compensatory changes- early and late
- 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
postural compensatory changes
- 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
postural compensatory changes- LE m asmmetry
- tight hamstrings (long side)
- tight rectus femoris (short side)
- tight adductors (short side)
iliolumbar ligament
-short leg side- tender point
gold standard- dx
-standing pelvis radiograph
tx
- level pelvis
- lift in shoe- start slowly!!
helig formula
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)
lift therapy
- 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
