Dataset Information

Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy.

ABSTRACT: Background: Mild leg length discrepancy can lead to musculoskeletal disorders; however, the magnitude starting from which leg length discrepancy alters the biomechanics of gait or benefits from treatment interventions is not clear. Research question: The aim of the current study was to examine the immediate effects of orthotic insoles on gait symmetry and pain on mild leg length discrepancy according to two groups of the leg length discrepancy (i.e., LLD ? 1 cm vs. LLD > 1 cm). Methods: Forty-six adults with mild leg length discrepancy were retrospectively included and classified into two groups (G_LLD?1cm or G_LLD>1cm). All subjects underwent routine 3D gait analysis with and without orthotic insoles. The symmetry index was calculated to assess changes in gait symmetry between the right and left limbs. Pain was rated without (in standing) and with the orthotic insoles (after 30 min of use) on a visual analog scale. Results: There was a significant improvement in the symmetry index of the pelvis in the frontal plane (p = 0.001) and the ankle in the sagittal plane (p = 0.010) in the stance with the orthotic insoles independent from the group. Pain reduced significantly with the orthotic insoles independently from the group (p < 0.001). Significance: Orthotic insoles significantly improved gait symmetry in the pelvis in the frontal plane and the ankle in the sagittal plane, as well as pain in all subjects (both LLD ? 1 cm and LLD > 1 cm) suggesting that it may be appropriate to treat even mild leg length discrepancy.

SUBMITTER: Menez C

PROVIDER: S-EPMC7750876 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy.

Menez Charlotte C L'Hermette Maxime M Coquart Jeremy J

Frontiers in sports and active living 20201216

Background: Mild leg length discrepancy can lead to musculoskeletal disorders; however, the magnitude starting from which leg length discrepancy alters the biomechanics of gait or benefits from treatment interventions is not clear. Research question: The aim of the current study was to examine the immediate effects of orthotic insoles on gait symmetry and pain on mild leg length discrepancy according to two groups of the leg length discrepancy (i.e., LLD ≤ 1 cm vs. LLD > 1 cm). ...[more]

PMID: 33367275

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Project description:BackgroundLeg-length inequality results in an altered position of the spine and pelvis. Previous studies on the influence of leg asymmetry on postural control have been inconclusive. The purpose of this paper was to investigate the effect of structural leg-length discrepancy (LLD) on the control of posture.MethodsWe studied 38 individuals (19 patients with structural LLD, 19 healthy subjects). The examination included measurement of the length of the lower limbs and weight distribution as well as a static posturography. All statistical analyses were performed with Statistica software version 10.0. Non-parametrical Kruskal-Wallis with Dunn's post test and Spearman test were used. Differences between the groups and correlation between mean COP sway velocity and the value of LLD as well as the value of LLD and weight distribution were assumed as statistically significant at p < 0.05.ResultsThere was a significant difference in the asymmetry of weight distribution between the group of patients and the healthy subjects (p = 0.0005). Differences in a posturographic examination between the groups were not statistically significant (p > 0.05). Meaningful differences in mean COP velocity in mediolateral direction between tandem stance with eyes open and closed were detected in both groups (in controls p = 0.000134, in patients both with the shorter leg in a front and rear position, p = 0.029, p = 0.026 respectively). There was a positive moderate correlation between the value of LLD and the value of mean COP velocity in normal standing in mediolateral direction with eyes open (r = 0.47) and closed (r = 0.54) and in anterioposterior plane with eyes closed (r = 0.05).ConclusionsThe fact that there were no significant differences in posturography between the groups might indicate compensations to the altered posture and neuromuscular adaptations in patients with structural leg-length inequality. LLD causes an increased asymmetry of weight distribution. This study confirmed a fundamental role of the sight in postural control, especially in unstable conditions. The analysis of mean COP sway velocity may suggest a proportional deterioration of postural control with the increase of the value of leg-length asymmetry.Trial registration numberTrial registry: ClinicalTrials.gov NCT03048656 , 8 February 2017 (retrospectively registered).

Project description:BackgroundFibular hemimelia has been reported as the most common congenital longitudinal deficiency of the long bones. Previous studies have focused on the best treatment options for this congenital condition. There is very little to our knowledge in the literature focused on residual persisting malformations and leg length discrepancy after treatment.MethodsSeven patients presenting fibular hemimelia in eight fibulae received treatment between years 1988 and 2001. Pre-treatment average leg length discrepancy was 5.3 cm. All patients presented associated congenital deformities of the ipsilateral leg. Six patients received surgical treatment. Average post-treatment follow up was 9.7 years. Residual malformations and leg length discrepancy were recorded for all patients. It is a retrospective case series study at one institution by two of the presenting authors as senior surgeons.ResultsAverage leg length gained after successful bone lengthening in six patients was 5.06 cm. Although there was a significant functional improvement, a number of residual malformations and leg length inequality was recorded. Residual average leg length discrepancy of 3.1 cm was observed in five patients who completed surgical treatment. Five patients presented a limp. Residual anterior-medial bowing of the tibia was observed in four patients. Calf atrophy was present in all seven patients. Valgus deformity of the ankle was remained in two patients.ConclusionsTreatment of fibular hemimelia, even in cases graded as successful, showed to be accompanied by a number of persisting residual deformities and recurrent leg length inequality. Although the number of patients is limited, the high rate of this phenomenon is indicative of the significance of the report. The family and the patients themselves should have the right expectations and will be more co-operative when well informed about this instance. A report of common post-treatment residual deformities should be valuable in best possible treatment planning of fibular hemimelia.

Project description:IntroductionUntreated unilateral developmental dysplasia of the hip (DDH) results in asymmetry of gait and hip strength and may lead to early osteoarthritis, which is commonly treated with a total hip arthroplasty (THA). There is limited knowledge about the obtained symmetry of gait and hip strength after the THA. The objectives of this cross-sectional study were to: a) identify asymmetries between the operated and non-operated side in kinematics, kinetics and hip strength, b) analyze if increased walking speed changed the level of asymmetry in patients c) compare these results with those of healthy subjects.MethodsWomen (18-70 year) with unilateral DDH who had undergone unilateral THA were eligible for inclusion. Vicon gait analysis system was used to collect frontal and sagittal plane kinematic and kinetic parameters of the hip joint, pelvis and trunk during walking at comfortable walking speed and increased walking speed. Furthermore, hip abductor and extensor muscle strength was measured.ResultsSix patients and eight healthy subjects were included. In the patients, modest asymmetries in lower limb kinematics and kinetics were present during gait, but trunk lateral flexion asymmetry was evident. Patients' trunk lateral flexion also differed compared to healthy subjects. Walking speed did not significantly influence the level of asymmetry. The hip abduction strength asymmetry of 23% was not statistically significant, but the muscle strength of both sides were significantly weaker than those of healthy subjects.ConclusionsIn patients with a DDH treated with an IBG THA modest asymmetries in gait kinematics and kinetics were present, with the exception of a substantial asymmetry of the trunk lateral flexion. Increased walking speed did not result in increased asymmetries in gait kinematics and kinetics. Hip muscle strength was symmetrical in patients, but significantly weaker than in healthy subjects. Trunk kinematics should be included as an outcome measure to assess the biomechanical benefits of the THA surgery after DDH.

Project description:In trotting horses, movement asymmetry is associated with ground reaction force asymmetry. In humans, limb length differences influence contralateral force production. Here we investigate whether horses, in immediate reaction to limb length changes, show movement asymmetry adaptations consistent with reported force differences. Aim of this study was to quantify pelvic and compensatory head and withers movement asymmetry as a function of limb length changes after application of orthotic lifts. In this experimental study movement asymmetry of eleven trotting horses was calculated from vertical displacement of poll, withers, sacrum and left and right tuber coxae with inertial sensors. Horses were assessed in-hand under 5 conditions (all with hind limb boots): without orthotic lifts, and with a 15mm or 30mm orthotic lift applied to the left hind or right hind. A linear mixed model investigated the influence of orthotic lift condition (P<0.05, pairwise posthoc Bonferroni correction). Pelvic movement asymmetry showed increased pelvic downward movement during stance of the shorter limb and increased pelvic upward movement during and after stance of the longer limb (P<0.001) with asymmetry changes of 3-7mm (4-10mm) for 15mm (30mm) lifts. Hip hike (tuber coxae movement asymmetry) was unaffected (P = 0.348). Head and withers movement asymmetry were affected less consistently (2 of 3 respectively 1 of 3 head or withers parameters). The small sample size of the study reduced generalizability, no direct force measurements were conducted and only immediate effects of orthotic lifts were assessed with no re-assessments days or weeks after. Conclusions about mechanical consequences (weight bearing, pushoff) are based on published movement-force associations. Pelvic movement asymmetry with an artificial change in limb length through application of an orthotic lift indicates increased weight support with the shorter limb and increased pushoff with the longer limb. This may be of relevance for the management of horses with different hoof shapes between contralateral limbs, for example some chronically lame horse.

Dataset Information

Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy.

Publications

Orthotic Insoles Improve Gait Symmetry and Reduce Immediate Pain in Subjects With Mild Leg Length Discrepancy.

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