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The effect of limb-length discrepancy on gait
K M Song1, S E Halliday, D G Little
1Texas Scottish Rite Hospital for Children, Dallas 75219, USA.
The Journal of Bone and Joint Surgery. American Volume
|December 31, 1997
Summary
Children with lower extremity limb length discrepancies (LLD) under 5.5% showed no compensatory gait changes. Greater LLDs led to increased work by the longer leg and altered body mass center, often resulting in toe-walking.
Area of Science:
- Orthopedics
- Biomechanics
- Pediatric Gait Analysis
Background:
- Limb length discrepancy (LLD) is a common condition in children.
- The impact of LLD on gait biomechanics requires further investigation, particularly in neurologically normal pediatric populations.
- Understanding compensatory strategies is crucial for managing LLD and preventing secondary musculoskeletal issues.
Purpose of the Study:
- To evaluate the kinematic and kinetic gait parameters in neurologically normal children with varying degrees of lower extremity LLD.
- To identify thresholds of LLD that elicit compensatory gait strategies.
- To correlate LLD magnitude with specific biomechanical adaptations during walking.
Main Methods:
- Gait analysis was performed on 35 neurologically normal children (22 boys, 13 girls; average age 13 years) with LLD ranging from 0.8% to 15.8%.
- Measurements included kinematic variables (e.g., pelvic obliquity) and kinetic variables.
- Children were assessed for angular or rotational deformities, which were absent in all participants.
Main Results:
- No significant correlation was found between the percentage or actual LLD and dependent kinematic or kinetic variables, including pelvic obliquity.
- LLD below 3% did not demonstrate associated compensatory gait strategies.
- LLD of 5.5% or greater was associated with increased mechanical work by the longer extremity and greater vertical displacement of the center of body mass, often manifesting as toe-walking.
Conclusions:
- Compensatory strategies for LLD in children are dependent on the magnitude of the discrepancy.
- Toe-walking emerges as a primary compensatory strategy for LLDs of 5.5% or more.
- Children with smaller LLDs (<5.5%) employ a combination of strategies to normalize lower extremity mechanical work, maintaining more typical gait patterns.