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Effect of Leg Length Discrepancy on Gait and Cobb's Angle

  • Park, Ki Han (Department of Physical Education, Graduate School of Incheon National University) ;
  • Kim, Kew Wan (Department of Physical Education, College of Arts and Physical Education, Incheon National University) ;
  • Kim, Chol Hee (Department of Physical Education, Graduate School of Incheon National University)
  • Received : 2016.01.30
  • Accepted : 2016.03.16
  • Published : 2016.03.31

Abstract

Objective: The purpose of this study was to investigate the effect of leg length discrepancy (LLD) on the human body during gait and standing posture. Methods: The study group comprised of 17 adult participants with LLDs of <1 cm. LLDs were artificially induced to 0, 1, 2, and 3 cm. The proportion of weight distribution, shift of the mean center of pressure, and Cobb's angle were measured in the standing position. Kinematic variables such as walking and striding width and time, and the proportion of stance phase for single- and double-limb gait were measured as well. The participants were required to either stand or walk on a treadmill (Zebris FDM) with a pressure plate, and the Cobb's angle measurements were obtained from radiographs. Results: A discrepancy of 3 cm in leg length resulted in a statistically significant shift of the center of pressure in the standing position. Moreover, the Cobb angle increased as the discrepancy became larger. The step length and width of the longer (left) leg during gait statistically significantly increased when the discrepancy was 2 cm. In addition, step time was statistically significant when the discrepancy between the longer (right) and shorter (left) legs was more than 2 cm. The proportion of single-limb stance phase was statistically significant as the discrepancy became larger, especially when the discrepancy was >2 cm for the longer (right) leg and 1 cm for the shorter (right) leg. Conclusion: The study showed that LLD influenced deformations of the human body and walking.

Keywords

References

  1. Ahn, M. (2004). The effects of postural correction on pelvis balance and cervical range of motion. Unpublished master's thesis, Daegu University, Daegu.
  2. Ames, R. A. (1985). Posture in the assessment, diagnosis and treatment of chronic low back pain. J Aust Chiropr Assoc, 15, 21-31.
  3. Beattie, P., Isaacson K., Riddle D. L. & Rothstein, J. M. (1990). Validity of derived measurements of leg-length differences obtained by use of a tape measure. Physical therapy, 70(3), 150-157. https://doi.org/10.1093/ptj/70.3.150
  4. Bhave, A., Paley, D. & Herzenberg, J. E. (1999). Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy. The Journal of Bone & Joint Surgery, 81(4), 529-534. https://doi.org/10.2106/00004623-199904000-00010
  5. Bolz, S. & Davies, G. J. (1984). Leg length differences and correlation with total leg strength. Journal of Orthopaedic & Sports Physical Therapy, 6(2), 123-129. https://doi.org/10.2519/jospt.1984.6.2.123
  6. Bunnell, W. P. (1986). The natural history of idiopathic scoliosis before skeletal maturity. Spine, 11(8), 773-776. https://doi.org/10.1097/00007632-198610000-00003
  7. Burcon, M. (2003). Assessment of the cervical spine using modified Prill leg Checks. 11th Annual Vertebral Subluxation. Research Conference.
  8. Carlson, M. & Wilkerson, J. (2007). Are differences in leg length predictive of lateral patello-femoral pain?. Physiotherapy Research International, 12(1), 29-38. https://doi.org/10.1002/pri.351
  9. Choi, H. S. & Min, K. J. (2000). The effect of the early therapeutic exercise on idiopathic scoliosis in elementary school children in seosan city. Korean research society of physical therapy, 3, 1-18.
  10. Dahl, M. T. (1996). Limb Length Discrepancy. Pediatric Clinic of North America, 43(4), 849-865. https://doi.org/10.1016/S0031-3955(05)70438-7
  11. Deacon, P., Flood, B. M. & Dickson, R. A. (1984). Idiopathic scoliosis in three dimensions. A radiographic and morphometric analysis. Journal of Bone & Joint Surgery, British Volume, 66(4), 509-512.
  12. Dirocco, P. J. & Vaccaro, P. (1998). Cardiopulmonary functioning in ddolescent patients with mild idiopathic scoliosis. Archives of physical medicine and rehabilitation, 69(3), 198-201.
  13. Friberg, O. (1983). Clinical symptoms and biomechanics of the lumbar spine and hip joint in leg-length inequality. Spine, 8(6), 643-651. https://doi.org/10.1097/00007632-198309000-00010
  14. Gailliet, R. (1990). Disorders and deformities. Philadelphia: WB Saunders, 792-809.
  15. Giles, L. G. (1981). Lumbosacral facetal 'joint angles' associated with leg length inequality. Rheumatol. Rehabil., 20(4), 233-238. https://doi.org/10.1093/rheumatology/20.4.233
  16. Golightly, Y. M., Allen, K. D., Renner, J. B., Helmick, C. G., Salazar, A. & Jordan, J. M. (2007). Relationship of limb length inequality with radiographic knee and hip osteoarthritis. Osteoarthritis and Cartilage, 15(7), 824-829. https://doi.org/10.1016/j.joca.2007.01.009
  17. Gong, W. T. (2008). The influence of contract-relax technique of PNF & sacroiliac jont mobilization of functional leg length inequality. Unpublished Doctor's Thesis, Daegu University, Gyeongbuk, Korea.
  18. Gurney, B., Mermier, C., Robergs, R., Gibbson, A. & Rivero, D. (2001). Effects of limb-length discrepancy on gait economy and lower-extermity muscle activity in older adults. The Journal of Bone and Joint Surgery, 83-A(6), 907-915.
  19. Hensinger, R. N. (1991). Congenital anomalies of the cervical spine. Clin Orthop., 264, 16-38.
  20. Hensinger, R. N. (1991). Congenital anomalies of the cervical spine. Clinical orthopaedics and related research, 264, 16-38.
  21. Hwang, S. S. (1997). The effects of vestibular stimulation on balance and fundamental psychological process fo children with central nervous system dysfunction. Unpublished Doctor's thesis, Dankook University, Seoul, Korea.
  22. Ikai, T., Kamikubo, T. & Takenhara, I. (2003). Dynamic Postural Control in Patients with hemiparesis. American journal of physical medicine & rehabilitation, 82(6), 463-469. https://doi.org/10.1097/01.PHM.0000069192.32183.A7
  23. Jang, M. J. & Cho, H. J. (2010). The effect of performing a 12 weeks's exercise program on the change of cobb's angle of disabled adolescents with idiopathic scoliosis. Korean journal of adapted physical activity, 18(4), 117-127. https://doi.org/10.17006/kjapa.2010.18.4.117
  24. Jeon, W. J. (2010). Interrelationship between difference in leg length of th lower limbs and the balance of the upper limbs musculoskeletal system of the students majoring in physical education: Through moire muscle somatotype photography. Unpublished Master's thesis, Myongji University, Seoul, Korea.
  25. Ji, S. G., Kim, M. K., Lee, D. G. & Cha, H. K. (2012). Effect of task-oriented exercise on the balance in degenerative arthritis patients with total knee replacement. The Journal of the Korea Contents Association, 12(3), 222-232. https://doi.org/10.5392/JKCA.2012.12.03.222
  26. Ju, H. Y. (2008). Effects of differences in shoulder height, leg length and foot arch height on weight distribution. Unpublished Master's thesis, Dongshin University, Jeonnam, Korea.
  27. Jung, Y. J. (2002). Effects of leg length discrepancy on kinemetic parameters during walking. Unpublished Master's thesis, Yousei University, Gangwon, Korea.
  28. Kang, H. S. (2006). Effects of the bareunmom (straight body form) physical exercise therapy on shoulder pain. Unpublished Master's Thesis, Chosun University, Gwangju, Korea.
  29. Kaufman, K. R., Miller, L. S. & Sutherland, D. H. (1996). Gait Asymmetry in Patients with Limb-Length Inequality. Journal of Pediatric Orthopaedics, 16(2), 144-150. https://doi.org/10.1097/01241398-199603000-00002
  30. Kim, S. & Kim, J. S. (2007). Knowledge of good posture and postural habits in elementary school children. Child health nursing research, 13(2), 182-190.
  31. Kwon, M. J., HwangBo, G. & Kim, J. S. (1993). The comparison of weight distribution between the healthy persons and low back pain patients during standing posture. The Journal of Korea society of physical therapy, 5(1), 9-15.
  32. Lawrence, D. (1984). Lateralization of wight in the presence of structural short leg. Journal of Manipulative and Physiologiacal Therapeutices, 7(2), 105-108.
  33. Lee, W. J. & Lim, C. H. (2012). Effect of unstable surface lumbar stabilization exercise on trunk posture and balance ability in patients with scoliosis. Journal of the korean society of physical medicine, 7(1), 59-67. https://doi.org/10.13066/kspm.2012.7.1.059
  34. Mahar, R. K., Kirby, R. L. & MacLeod, D. A. (2005) Simulated leg-length discrepancy: its effect on mean center-ofpressure position and postural sway. Arch Phys Med Rehabil, 66(12), 822-824.
  35. McCaw, S. T. (1992). Leg length inequality Implications for running injury prevention. Sports Med, 14(6), 422-429. https://doi.org/10.2165/00007256-199214060-00008
  36. Moseley, C. F. (1986). Leg-Length Discrepancy. Pediatric Clinics of North America, 33(6), 1385-1394. https://doi.org/10.1016/S0031-3955(16)36149-1
  37. Murray, M. P., Drought, A. B. & Kory, R. C. (1964). Walking patterns of normal men. Jounal of Bone Joint Surgery, 46, 335-360. https://doi.org/10.2106/00004623-196446020-00009
  38. O'Brien, S., Kernohan, G., Fitzpatrick, C., Hill, J. & Beverland, D. (2010). Perception of imposed leg length inequality in normal subjects. Hip international: the journal of clinical and experimental research on hip pathology and therapy, 20(4), 505-511.
  39. Papaioanou, T., Stokes, I. & Kenwright, J. (1982). Scoliosis associated with limb-length inequality. J Bone Joint Surg. Am., 64(1), 59-62. https://doi.org/10.2106/00004623-198264010-00009
  40. Park, B. G. (2012). Relationships between differences in shoulder height, leg length, arch height and weight distribution on anthropometric variables. The korea journal of sports science, 21(4), 1199-1213.
  41. Park, Y. S. & Lim, Y. T. (2014). Effects of the functional Garment wear on Cobb's Angle and Com of trunk and pelvic during gait for Adolescent Idiopathic scoliosis patients. Korean Journal of Sport Biomechanics, 24(3), 269-275. https://doi.org/10.5103/KJSB.2014.24.3.269
  42. Patla, A. E. (1993). Age-related changes in visually guided locomotion over different terrains. major issues in: Amsterdam, Netherlands: Kluwer Academic.
  43. Payne, W. K., Oqilvie, J. W., Resnick, M. D., Kane, R. L., Transfeldt, E. E. & Blum, R. W. (1997). Does scoliosis have a psychological impact and does gender make a difference. Spine, 22(12), 1380-1384. https://doi.org/10.1097/00007632-199706150-00017
  44. Perry, J. (1992). Gait analysis: Normal and Pathological Function. 1st ed., SIACK incorporated, NJ; Thorofare.
  45. Perttunen, J. R., Anttila, E., Sodergard, J., Merikanto, J. & Komi, P. (2004). Gait asymmetry in patients with limb length discrepancy. Scandinavian Jorunal of Medical Science Sports, 14(1), 49-56. https://doi.org/10.1111/j.1600-0838.2003.00307.x
  46. Ramirez, N., Jonstone, C. E. & Browne, R. H. (1997). The prevalance of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am, 79(3), 364-368. https://doi.org/10.2106/00004623-199703000-00007
  47. Rush, W. A. & Steiner, H. A. (1946). A study of lower extremity length inequality. The American journal of roentgenology and radium therapy, 56(5), 613-623.
  48. Ryu, J. S. & Lim, G. Y. (2015). Impact shock components and attenuation in flat foot running. Korean Journal of Sport Biomechanics, 25(3), 283-291. https://doi.org/10.5103/KJSB.2015.25.3.283
  49. Strecker, W., Franzreb, M., Pfeiffer, T., Pokar, S., Wikstrom, M. & Kinzl, L. (1994). Computerized tomography measurement of torsion angle of the lower extremities. Unfallchirurg, 97(11), 609-613.
  50. Subotnick, S. I. (1981). Leg length discrepancies of the lower extremity. J Orthop Sports Phys Ther, 3(1), 11-16. https://doi.org/10.2519/jospt.1981.3.1.11
  51. Waidelich, H. A., Strecker, W. & Schneider, E. (1992). Computed tomographic torsion angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo., 157(3), 245-251. https://doi.org/10.1055/s-2008-1033007
  52. White S. C., Gilchist, L. A. & Wilk, B. E. (2004). Asymmetric limb loading with true or simulated leg-length differences. Clinical Orthopedic Relation Research, 421, 287-292. https://doi.org/10.1097/01.blo.0000119460.33630.6d
  53. Winter, R. B. & Pinto, W. C. (1986). Pelvic obliquity. Its causes and its teratment. Spine, 11(3), 225-234. https://doi.org/10.1097/00007632-198604000-00008
  54. Woo, B. H. (2014). Characteristics for gait of the induced equinus in normal subjects. Korean Journal of Sport Biomechanics, 24(4), 435-443. https://doi.org/10.5103/KJSB.2014.24.4.435
  55. Yang, Y. R., Chung, Y. C., Lee, C. S., Cheng, S. J. & Wang, R. Y. (2007). Dualtask-related gaitchanges in individuals with stroke. Gait & Posture, 25(2), 185-190. https://doi.org/10.1016/j.gaitpost.2006.03.007
  56. Yoon, T. S., Jeon, S. I., Shin, J. S. & Park, B. G. (1990). A study of isokinetic testing at the knee comparing soccer players and non-players. Annals of rehabilitation medicine, 14(2), 260-267.

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