Северо-Западный государственный медицинский университет им. И.И. Мечникова Минздрава России, Санкт-Петербург, Россия
INTRODUCTION. Biomechanical abnormalities caused by limb length discrepancy are controversial problems of pediatric orthopedics. AIM. To assess the influence of limb length discrepancy and its compensation in children on the amplitude of pelvic motion in the frontal plane during walking. MATERIAL AND METHODS. We examined the study group of 21 patients with (the average discrepancy was 2,86% (from 0,23% to 6,12%). Biomechanical examination consisted of dynamic optical computed topography. The study was carried out in standard shoes and in shoes with compensation. The average compensation was 14 mm (from 5 to 45 mm). The comparison group consisted of 19 healthy children without limb length discrepancy. The angle of frontal asymmetry of the pelvis was calculated as the absolute difference in inclination. RESULTS AND DISCUSSION. When compensation was used, the amplitude of pelvic movements changed insignificantly, by an average of 1.84°, in children with discrepancy of the lower limbs. In the comparison group (healthy children), we also did not observe any changes in frontal pelvic oscillation when imitating variability compared to tests without compensation. The most obvious explanation for this phenomenon is the formation of additional compensation mechanisms for different lengths of the lower limbs. CONCLUSION. Compensation of limb length discrepancy requires an individualized approach and additional walking examinations of the patient. Further research will expand our understanding of the role of compensation for limb length discrepancy both in conservative treatment and in planning for surgical interventions.
limb length discrepancy, shoe lift, heel pad, pelvic obliquity, walking, pediatric orthopedics
1. Brady R.J., John B. Dean J.B., Marc Skinner M.T., Gross M.T. Limb length inequality: clinical implications for assessment and intervention. Journal of Orthopaedic & Sports Physical Therapy. 2003; 33(5): 221-234. https://www.jospt.org/doi/10.2519/jospt.2003.33.5.221
2. Zuckerman S.L., Lai C.S. et al. Understanding the role of pelvic obliquity and leg length discrepancy in adult spinal deformity patients with coronal malalignment: unlocking the black box. Journal of Neurosurgery: Spine. 2022; (1): 1-9. https://doi.org/10.3171/2021.10.SPINE21800
3. Kobayashi K., Ando K. et al. Scoliosis caused by limb-length discrepancy in children. Asian Spine Journal. 2020; 14(6): 801 p. https://doi.org/10.31616/asj.2019.0374
4. Batrshin I.T., Sadovaya T.N. Raznovysokost' nizhnih konechnostey s perekosom taza i frontal'naya deformaciya pozvonochnika. Hirurgiya pozvonochnika. 2007; (3): 039-044. https://doi.org/10.14531/ss2007.3.39-44
5. Sanhudo J.A.V., Gomes J.L.E. Association between leg length discrepancy and posterior tibial tendon dysfunction. Foot & Ankle Specialist. 2014; 7(2): 119-126. https://doi.org/10.1177/1938640014522096
6. Mahmood S., Huffman L.K., Harris J.G. Limb-length discrepancy as a cause of plantar fasciitis. Journal of the American Podiatric Medical Association. 2010; 100(6): 452-455.
7. Golightly Y.M., Allen K.D., Helmick C.G., Renner J.B., Jordan J.M. Symptoms of the knee and hip in individuals with and without limb length inequality. Osteoarthritis and cartilage. 2009; 17(5): 596-600. https://doi.org/10.1016/j.joca.2008.11.005
8. Harvey W.F., Yang M., Cooke T.D.V. et al. Association of leg-length inequality with knee osteoarthritis: a cohort study. Annals of Internal Medicine. 2010; 152(5): 287-295. https://doi.org/10.7326/0003-4819-152-5-201003020-00006
9. Murray K.J., Azari M.F. Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine. The Journal of the Canadian Chiropractic Associ- ation. 2015; 59(3): 226-237.
10. Balik M.S., Kanat A., Erkut A., Ozdemir B., Batcik O.E. Inequality in leg length is important for the understanding of the pathophysiology of lumbar disc herniation. Journal of Craniovertebral Junction & Spine. 2016; 7(2): 87-90. https://doi.org/10.4103/0974-8237.181829
11. Moreno D’Amico M., Kinel E., Piero Roncoletta P. Leg Length Discrepancy and Nonspecific Low Back Pain: 3D Stereophotogrammetric Quantitative Posture Evaluation Confirms Positive Effects of Customized Heel-Lift Orthotics. Frontiers in Bioengineering and Biotechnology. 2021; (9): 743132. https://doi.org/10.3389/fbioe.2021.743132
12. Kendall J.C., Bird A.R., Azari M.F. Foot posture, leg length discrepancy and low back pain - Their relationship and clinical management using foot orthoses - An overview. The Foot. 2014; 24(2): 75-80. https://doi.org/10.1016/j.foot.2014.03.004
13. Khamis S., Carmeli E. Relationship and significance of gait deviations associated with limb length discrepancy: a systematic review. Gait & Posture. 2017; (57): 115-123. https://doi.org/10.1016/j.gaitpost.2017.05.028
14. Siebers H.L., Eschweiler J., Michalik R., Migliorini F., Tingart M., Betsch M. Biomechanical compensation mechanisms during stair climbing - The effect of leg length inequalities. Gait & Posture. 2022; (91): 290-296. https://doi.org/10.1016/j.gaitpost.2021.10.030
15. Buyukaslan A., Abul K., Berk H., Yilmaz H. Leg length discrepancy and adolescent idiopathic scoliosis: clinical and radiological characteristics. Spine Deformity. 2022; 10(2): 307-314. https://doi.org/10.1007/s43390-021-00417-0
16. Shi Y., Pang h., Xu H., Li X., Cao Y. et al. Effects of orthotic insole on gait patterns in children with mild leg length discrepancy. Gait & Posture. 2022; (93): 191-197. https://doi.org/10.1016/j.gaitpost.2022.02.003
17. Tirtashi F.H., Eslami M., Taghipour M. Effect of shoe insole on the dynamics of lower extremities in individuals with leg length discrepancy during walking. Journal of Bodywork and Movement Therapies. 2022; (31): 51-56. https://doi.org/10.1016/j.jbmt.2022.03.006
18. Aiona M., Patrick K.D., Khaled E., Robin D., Rosemary P. Gait patterns in children with limb length discrepancy. Journal of Pediatric Orthopaedics. 2015; 35(3): 280-284. https://doi.org/10.1097/BPO.0000000000000262
19. Vogt B., Gosheger G., Wirth T., Horn J., Rödl R. Leg length discrepancy -treatment indications and strategies. Deutsches Ärzteblatt International. 2020; 117(24): 405-11. https://doi.org/10.3238/arztebl.2020.0405
20. Kim Y. Effect of correction of leg length discrepancy on the biomechanical characteristics of the pelvis and hip joints among standing workers. Work. 2022; 71(4): 1129-1136. https://doi.org/10.3233/WOR-205160
21. Bangerter C., Romkes J., Lorenzetti S. et al. What are the biomechanical consequences of a structural leg length discrepancy on the adolescent spine during walking? Gait & Posture. 2019; (68): 506-513. https://doi.org/10.1016/j.gaitpost.2018.12.040
22. Yong M.S., Park S.H. Leg length discrepancy to influence on kinematic changes of the pelvis and the hip during gait. The Journal of Korean Physical Therapy. 2019; 31(6): 368-371. https://doi.org/10.18857/jkpt.2019.31.6.368
23. Petrova D.A., Kenis V.M. Ocenka otnositel'nyh parametrov raznovelikosti nizhnih konechnostey u detey pri ispol'zovanii vremennogo epifizeodeza 8-obraznymi plastinami. Ortopediya, travmatologiya i vosstanovitel'naya hirurgiya detskogo vozrasta. 2022; 10(2): 151-160. https://doi.org/10.17816/PTORS104405
