Gait Patterns in Children With Limb Length Discrepancy

Aiona, Michael D.; Patrick, K.; Emara, Khaled; Dorociak, Robin; Pierce, Rosemary

doi:10.1097/bpo.0000000000000262

Cited by 60 publications

(52 citation statements)

References 14 publications

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“…For comparison, pain studies have shown between 20 and 60% decreases in weight bearing in rats with unilaterally induced osteoarthritis ( 71 , 79 ). Our results are consistent with experiments that have found changes in gait, muscle exertion, and oxygen consumption with mild (<1–2 cm) limb length inequality in humans ( 24 , 39 – 41 , 80 , 81 ). Our findings (Figure 4 B) are also consistent with human studies that have shown gait asymmetry increases as the magnitude of limb length inequality increases ( 18 , 41 ).…”

Section: Discussionsupporting

confidence: 93%

Heat-Induced Limb Length Asymmetry Has Functional Impact on Weight Bearing in Mouse Hindlimbs

et al. 2018

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Limb length inequality results from many types of musculoskeletal disorders. Asymmetric weight bearing from a limb length discrepancy of less than 2% can have debilitating consequences such as back problems and early-onset osteoarthritis. Existing treatments include invasive surgeries and/or drug regimens that are often only partially effective. As a noninvasive alternative, we previously developed a once daily limb-heating model using targeted heat on one side of the body for 2 weeks to unilaterally increase bone length by up to 1.5% in growing mice. In this study, we applied heat for 1 week to determine whether these small differences in limb length are functionally significant, assessed by changes in hindlimb weight bearing. We tested the hypothesis that heat-induced limb length asymmetry has a functional impact on weight bearing in mouse hindlimbs. Female 3-week-old C57BL/6 mice (N = 12 total) were treated with targeted intermittent heat for 7 days (40 C for 40 min/day). High-resolution x-ray (N = 6) and hindlimb weight bearing data (N = 8) were acquired at the start and end of the experiments. There were no significant left-right differences in starting tibial length or hindlimb weight bearing. After 1-week heat exposure, tibiae (t = 7.7, p < 0.001) and femora (t = 11.5, p < 0.001) were ~1 and 1.4% longer, respectively, on the heat-treated sides (40 C) compared to the non-treated contralateral sides (30 C). Tibial elongation rate was over 6% greater (t = 5.19, p < 0.001). Hindlimb weight bearing was nearly 20% greater (t = 11.9, p < 0.001) and significantly correlated with the increase in tibial elongation rate on the heat-treated side (R2 = 0.82, p < 0.01). These results support the hypothesis that even a small limb length discrepancy can cause imbalanced weight distribution in healthy mice. The increase in bone elongation rate generated by localized heat could be a way to equalize limb length and weight bearing asymmetry caused by disease or trauma, leading to new approaches with better outcomes by using heat to lengthen limbs and reduce costly side effects of more invasive interventions.

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Section: Discussionsupporting

confidence: 93%

Heat-Induced Limb Length Asymmetry Has Functional Impact on Weight Bearing in Mouse Hindlimbs

et al. 2018

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“…Differences in limb lengths as small as 4% have been shown to cause back pain in adults ( Knutson, 2005 ). Children with >5.5% difference in limb lengths demonstrated gait compensations that would be expected to lead to secondary pathologies later in life ( Aiona et al , 2014 ). Therefore the magnitude of the discrepancy shown here is well greater than what would be expected to result in secondary skeletal problems ( Walsh et al , 2000 ; Aiona et al , 2014 ).…”

Section: Resultsmentioning

confidence: 99%

“…Children with >5.5% difference in limb lengths demonstrated gait compensations that would be expected to lead to secondary pathologies later in life ( Aiona et al , 2014 ). Therefore the magnitude of the discrepancy shown here is well greater than what would be expected to result in secondary skeletal problems ( Walsh et al , 2000 ; Aiona et al , 2014 ). There was no difference between tibiae length in normal control mice that had not undergone surgery compared with the contralateral limb in mice that had undergone the surgery.…”

Section: Resultsmentioning

confidence: 99%

Mechanical loading regulates organization of the actin cytoskeleton and column formation in postnatal growth plate

Killion

Mitchell

Duke

et al. 2017

MBoC

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“…Those authors also reported compensatory strategies involving both the shorter and longer limbs, with the magnitude of compensation proportional to the size of the LLD. Most investigators agree that pelvic obliquity is a common compensatory strategy during gait among patients with LLD 6,[15][16][17][18][19] .…”

Section: Spine Biomechanics During Gait In Patients With Lldmentioning

confidence: 99%

Leg-Length Discrepancy, Functional Scoliosis, and Low Back Pain

Sheha¹,

Steinhaus²,

Kim³

et al. 2018

JBJS Rev

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» In the setting of leg-length discrepancy (LLD), functional scoliosis occurs when the lumbar spine compensates for pelvic obliquity to maintain shoulder balance. » Long-standing LLD may result in degenerative changes of the lumbar spine, altered gait mechanics, and low back pain. » Patients with LLD, low back pain, and functional scoliosis should undergo radiographic evaluation with the pelvis leveled using blocks placed under the shorter limb. When the LLD or symptoms are minimal, patients may benefit from a shoe lift. Patients with an LLD of .20 mm may be considered for operative intervention.

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Gait Patterns in Children With Limb Length Discrepancy

Abstract: Level II.

Cited by 60 publications

References 14 publications

Heat-Induced Limb Length Asymmetry Has Functional Impact on Weight Bearing in Mouse Hindlimbs

Heat-Induced Limb Length Asymmetry Has Functional Impact on Weight Bearing in Mouse Hindlimbs

Mechanical loading regulates organization of the actin cytoskeleton and column formation in postnatal growth plate

Leg-Length Discrepancy, Functional Scoliosis, and Low Back Pain

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