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Effects of Artificial Leg Length Discrepancies on the Dynamic Joint Angles of the Hip, Knee, and Ankle During Gait

  • Kim, Yong-Wook (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Jo, Seung-Yeon (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Byeon, Yeoung-In (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Kwon, Ji-Ho (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Im, Seok-Hee (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Cheon, Su-Hyeon (Department of Physical Therapy, College of Medical Sciences, Jeonju University) ;
  • Kim, Eun-Joo (Department of Occupational Therapy, College of Medical Sciences, Jeonju University)
  • Received : 2018.12.04
  • Accepted : 2019.01.03
  • Published : 2019.02.28

Abstract

PURPOSE: This study examined the dynamic range of motion (ROM) of the hip, knee, and ankle joint when wearing different shoe sole lifts, as well as the limb asymmetry of the range according to the leg length discrepancy (LLD) during normal speed walking. METHODS: The participants were 40 healthy adults. A motion analysis system was used to collect kinematic ROM data. The participants had 40 markers attached to their lower extremities and were asked to walk on a 6 m walkway, under three different shoe lift conditions (without an insole, 1 cm insole, and 2 cm insole). Visual3D professional software was used to coordinate kinematic ROM data. RESULTS: Most of the ROM variables of the short limbs were similar under each insole lift condition (p>.05). In contrast, when wearing a shoe with a 2 cm insole lift, the long limbs showed significant increases in flexion and extension of the knee joint as well as; plantarflexion, dorsiflexion, pronation, eversion, and inversion of the ankle joint (p<.05). Of the shoes with the insole lifts, significant differences in all ROM variables were observed between the left and right knees, except for the knee internal rotation (p<.05). CONCLUSION: As the insole lift was increased, more ROM differences were observed between the left and right limbs, and the asymmetry of the bilateral lower limbs increased. Therefore, appropriate interventions for LLD are needed because an artificial mild LLD of less than 2.0 cm could lead to a range of musculoskeletal problems of the lower extremities, such as knee and ankle osteoarthritis.

Keywords

References

  1. Azizan NA, Basaruddin KS, Salleh AF. The Effects of Leg Length Discrepancy on Stability and Kinematics-Kinetics Deviations: A Systematic Review. Appl Bionics Biomech. 2018:5156348. https://doi.org/10.1155/2018/5156348
  2. Beattie P, Isaacson K, Riddle DL, et al. Validity of derived measurements of leg-length differences obtained by use of a tape measure. Phys Ther. 1990;70(3):150-7. https://doi.org/10.1093/ptj/70.3.150
  3. Bennell K, Matheson G, Meeuwisse W, et al. Risk factors for stress fractures. Sports Med. 1999;28(2):91-122. https://doi.org/10.2165/00007256-199928020-00004
  4. Blake RL, Ferguson HJ. Correlation between limb length discrepancy and asymmetrical rearfoot position. J Am Podiatr Med Assoc. 1993;83(11):625-33. https://doi.org/10.7547/87507315-83-11-625
  5. Collins TD, Ghoussayni SN, Ewins DJ, et al. A six degrees-of-freedom marker set for gait analysis: repeatability and comparison with a modified Helen Hayes set. Gait Posture. 2009;30(2):173-80. https://doi.org/10.1016/j.gaitpost.2009.04.004
  6. Defrin R, Ben Benyamin S, Aldubi RD, et al. Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain. Arch Phys Med Rehabil. 2005;86(11):2075-80. https://doi.org/10.1016/j.apmr.2005.06.012
  7. Goel A, Loudon J, Nazare A, et al. Joint moments in minor limb length discrepancy: a pilot study. Am J Orthop (Belle Mead NJ). 1997;26(12):852-6.
  8. Gross RH. Leg length discrepancy in marathon runners. Am J Sports Med. 1983;11(3):121-4. https://doi.org/10.1177/036354658301100303
  9. Guichet JM, Spivak JM, Trouilloud P, et al. Lower limb-length discrepancy. An epidemiologic study. Clin Orthop Relat Res. 1991;272:235-41.
  10. Gurney B, Mermier C, Robergs R, et al. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am. 2001;83-A(6):907-15.
  11. Hellsing AL. Leg length inequality. A prospective study of young men during their military service. Ups J Med Sci. 1988;93(3):245-53. https://doi.org/10.3109/03009738809178550
  12. Kakushima M, Miyamoto K, Shimizu K. The effect of leg length discrepancy on spinal motion during gait: three-dimensional analysis in healthy volunteers. Spine (Phila Pa 1976). 2003;28(21):2472-6. https://doi.org/10.1097/01.BRS.0000090829.82231.4A
  13. Kaufman KR, Miller LS, Sutherland DH. Gait asymmetry in patients with limb-length inequality. J Pediatr Orthop. 1996;16(2):144-50. https://doi.org/10.1097/01241398-199603000-00002
  14. Khamis S, Carmeli E. Relationship and significance of gait deviations associated with limb length discrepancy: A systematic review. Gait Posture. 2017;57:115-23. https://doi.org/10.1016/j.gaitpost.2017.05.028
  15. Mahmood S, Huffman LK, Harris JG. Limb-length discrepancy as a cause of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100(6):452-5. https://doi.org/10.7547/1000452
  16. Needham R, Chockalingam N, Dunning D, et al. The effect of leg length discrepancy on pelvis and spine kinematics during gait. Stud Health Technol Inform. 2012;176:104-7.
  17. O'Toole GC, Makwana NK, Lunn J, et al. The effect of leg length discrepancy on foot loading patterns and contact times. Foot Ankle Int. 2003;24(3):256-9. https://doi.org/10.1177/107110070302400310
  18. Raczkowski JW, Daniszewska B, Zolynski K. Functional scoliosis caused by leg length discrepancy. Arch Med Sci. 2010;6(3):393-8. https://doi.org/10.5114/aoms.2010.14262
  19. Resende RA, Kirkwood RN, Deluzio KJ, et al. Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait. Gait Posture. 2016;46:147-53. https://doi.org/10.1016/j.gaitpost.2016.03.012
  20. Resende RA, Kirkwood RN, Deluzio KJ, et al. Mild leg length discrepancy affects lower limbs, pelvis and trunk biomechanics of individuals with knee osteoarthritis during gait. Clin Biomech (Bristol, Avon). 2016;38:1-7. https://doi.org/10.1016/j.clinbiomech.2016.08.001
  21. Sabharwal S, Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008;466(12):2910-22. https://doi.org/10.1007/s11999-008-0524-9
  22. Walsh M, Connolly P, Jenkinson A, et al. Leg length discrepancy--an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture. 2000;12(2):156-61. https://doi.org/10.1016/S0966-6362(00)00067-9
  23. Wretenberg P, Hugo A, Brostrom E. Hip joint load in relation to leg length discrepancy. Med Devices (Auckl). 2008;1:13-8.
  24. Zeitoune G, Nadal J, Batista LA, et al. Prediction of mild anatomical leg length discrepancy based on gait kinematics and linear regression model. Gait Posture. 2019;67:117-21. https://doi.org/10.1016/j.gaitpost.2018.09.027