Effects of Limb-Length Discrepancy on Gait Economy and Lower-Extremity Muscle Activity in Older Adults

Purpose Klippel-Trenaunay syndrome (KTS) is a rare combined vascular malformation composed of capillary malformation, lymphatic and/or venous malformation and limb overgrowth, which commonly affects the extremities. Due to limb involvement, it is not uncommon for these patients to require referral to an orthopaedic surgeon. Herein we reviewed the prevalence of orthopaedic diagnoses in a large cohort of KTS patients and described the associated surgical interventions. Methods Between 1976 and 2012, 410 patients fulfilling strict criteria for KTS were evaluated at a single institution. Patient charts were reviewed for demographic information, details of the clinical evaluation, orthopaedic consultation and surgical interventions. Results A total of 264 of 410 patients (64%) with confirmed KTS required orthopaedic evaluation. Of these 264 patients, 84% had documented limb-length discrepancy. Other common diagnoses included: angular deformities (10%), scoliosis (9%), osteopenia/osteoporosis (7%), pathological fractures (6%), joint contracture (5%), degenerative joint disease (4%) and limb/joint pain (4%). Of the 264 patients evaluated by orthopaedic surgery, 133 patients (50.4%) underwent 169 surgeries. Surgery was most commonly performed for limb-length discrepancy (62%). Multivariable analysis confirmed an orthopaedic condition was more likely in patients with lymphatic malformation (odds ratio (OR) 3.78; p < 0.001), as well as in those with bone and/or soft-tissue hypertrophy of the lower extremity (OR 7.51; p < 0.001) or foot (OR 3.23; p < 0.001). Conclusion Orthopaedic conditions are common in patients with KTS and approximately 50% require surgical intervention. Those with a lymphatic malformation and/or soft-tissue hypertrophy of the lower extremity are more likely to need surgery. Level of Evidence Level IV, Descriptive Case Series

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Comparison of PACS and Bone Ninja mobile application for assessment of lower extremity limb length discrepancy and alignment

Journal of Children s Orthopaedics ◽

10.1007/s11832-016-0761-5 ◽

2016 ◽

Vol 10 (5) ◽

pp. 439-443 ◽

Cited By ~ 6

Author(s):

Amanda T. Whitaker ◽

Martin G. Gesheff ◽

Julio J. Jauregui ◽

John E. Herzenberg

Keyword(s):

Lower Extremity ◽

Mobile Application ◽

Limb Length Discrepancy ◽

Limb Length ◽

Length Discrepancy

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The efficacy of two-hole tension band plates in the treatment of lower extremity limb length discrepancy

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000861 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Erdi Ozdemir ◽

Riza Mert Cetik ◽

Mehmet Ayvaz ◽

Guney Yilmaz

Keyword(s):

Lower Extremity ◽

Limb Length Discrepancy ◽

Tension Band ◽

Limb Length ◽

Length Discrepancy

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Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00260-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Chisato Hayashi ◽

Soshiro Ogata ◽

Tadashi Okano ◽

Hiromitsu Toyoda ◽

Sonoe Mashino

Keyword(s):

Older Adults ◽

Muscle Strength ◽

Physical Exercise ◽

Lower Extremity ◽

Physical Function ◽

Community Dwelling ◽

Group Exercise ◽

Community Based ◽

Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

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Intramedullary Bone Lengthening Following Preceding Hip Surgery—A Case Series

Journal of Clinical Medicine ◽

10.3390/jcm9124104 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4104

Author(s):

Lukas Zak ◽

Thomas Manfred Tiefenboeck ◽

Gerald Eliot Wozasek

Keyword(s):

Hip Dysplasia ◽

Young Patients ◽

Limb Lengthening ◽

Limb Length Discrepancy ◽

Limb Length ◽

Hip Surgery ◽

Bone Lengthening ◽

Safe Procedure ◽

Length Discrepancy ◽

Healing Index

Limb length discrepancy (LLD) is a common problem after joint-preserving hip surgeries, hip dysplasia, and hip deformities. Limping, pain, sciatica, paresthesia, and hip instability are common clinical findings and may necessitate limb-lengthening procedures. The study included five patients (two female and three male, mean age of 28 years (20–49; SD: 12)) with symptomatic limb length discrepancy greater than 2.5 cm (mean: 3.6 cm) after total hip arthroplasty (THA), hip dysplasia, or post-traumatic hip surgery. They underwent either ipsi- or contralateral intramedullary limb-lengthening surgeries using the PRECICE™ telescopic nail. All patients achieved complete bone healing and correction of the pelvic obliquity after intramedullary lengthening. None of the patients had a loss of proximal or distal joint motion. The mean distraction-consolidation time (DCT) was 3.8 months, the distraction index (DI) 0.7 mm/day, the lengthening index (LI) 1.8 months/cm, the consolidation index (CI) 49.2 days/cm, the healing index (HI) 1.1 months/cm, and the modified healing index (HI*) 34 days/cm. Intramedullary limb lengthening after LLD in cases of hip dysplasia, hip deformity, and various kinds of hip surgery is a useful and safe procedure in young patients to achieve equal limb length. No functional impairment of the preceded hip surgery was seen.

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Lower extremity muscle quality and gait variability in older adults

Age and Ageing ◽

10.1093/ageing/afs032 ◽

2012 ◽

Vol 41 (5) ◽

pp. 595-599 ◽

Cited By ~ 39

Author(s):

Sunghoon Shin ◽

Rudy J. Valentine ◽

Ellen M. Evans ◽

Jacob J. Sosnoff

Keyword(s):

Older Adults ◽

Lower Extremity ◽

Gait Variability ◽

Muscle Quality ◽

Lower Extremity Muscle

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Lower-Extremity Muscle Activity During Aquatic and Land Treadmill Running at the Same Speeds

Journal of Sport Rehabilitation ◽

10.1123/jsr.2013-0003 ◽

2014 ◽

Vol 23 (2) ◽

pp. 107-122 ◽

Cited By ~ 5

Author(s):

W. Matthew Silvers ◽

Eadric Bressel ◽

D. Clark Dickin ◽

Garry Killgore ◽

Dennis G. Dolny

Keyword(s):

Lower Extremity ◽

Outcome Measures ◽

Muscle Activity ◽

Tibialis Anterior ◽

Rectus Femoris ◽

Biceps Femoris ◽

Swing Phase ◽

Treadmill Running ◽

Vastus Medialis ◽

Lower Extremity Muscle

Context:Muscle activation during aquatic treadmill (ATM) running has not been examined, despite similar investigations for other modes of aquatic locomotion and increased interest in ATM running.Objectives:The objectives of this study were to compare normalized (percentage of maximal voluntary contraction; %MVC), absolute duration (aDUR), and total (tACT) lower-extremity muscle activity during land treadmill (TM) and ATM running at the same speeds.Design:Exploratory, quasi-experimental, crossover design.Setting:Athletic training facility.Participants:12 healthy recreational runners (age = 25.8 ± 5 y, height = 178.4 ± 8.2 cm, mass = 71.5 ± 11.5 kg, running experience = 8.2 ± 5.3 y) volunteered for participation.Intervention:All participants performed TM and ATM running at 174.4, 201.2, and 228.0 m/min while surface electromyographic data were collected from the vastus medialis, rectus femoris, gastrocnemius, tibialis anterior, and biceps femoris.Main Outcome Measures:For each muscle, a 2 × 3 repeated-measures ANOVA was used to analyze the main effects and environment–speed interaction (P ≤ .05) of each dependent variable: %MVC, aDUR, and tACT.Results:Compared with TM, ATM elicited significantly reduced %MVC (−44.0%) but increased aDUR (+213.1%) and tACT (+41.9%) in the vastus medialis, increased %MVC (+48.7%) and aDUR (+128.1%) in the rectus femoris during swing phase, reduced %MVC (−26.9%) and tACT (−40.1%) in the gastrocnemius, increased aDUR (+33.1%) and tACT (+35.7%) in the tibialis anterior, and increased aDUR (+41.3%) and tACT (+29.2%) in the biceps femoris. At faster running speeds, there were significant increases in tibialis anterior %MVC (+8.6−15.2%) and tACT (+12.7−17.0%) and rectus femoris %MVC (12.1−26.6%; swing phase).Conclusion:No significant environment–speed interaction effects suggested that observed muscle-activity differences between ATM and TM were due to environmental variation, ie, buoyancy (presumed to decrease %MVC) and drag forces (presumed to increase aDUR and tACT) in the water.

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Role of Occupational Footwear and Prolonged Walking on Lower Extremity Muscle Activation during Maximal Exertions and Postural Stability Tasks

Biomechanics ◽

10.3390/biomechanics1020017 ◽

2021 ◽

Vol 1 (2) ◽

pp. 202-213

Author(s):

Harish Chander ◽

Sachini N. K. Kodithuwakku Arachchige ◽

Alana J. Turner ◽

Reuben F. Burch V ◽

Adam C. Knight ◽

...

Keyword(s):

Lower Extremity ◽

Muscle Activity ◽

Repeated Measures ◽

Postural Stability ◽

Muscle Activation ◽

Medial Gastrocnemius ◽

Lower Extremity Muscle ◽

Prolonged Duration ◽

The Mean ◽

The Impact

Background: Occupational footwear and a prolonged duration of walking have been previously reported to play a role in maintaining postural stability. The purpose of this paper was to analyze the impact of three types of occupational footwear: the steel-toed work boot (ST), the tactical work boot (TB), and the low-top work shoe (LT) on previously unreported lower extremity muscle activity during postural stability tasks. Methods: Electromyography (EMG) muscle activity was measured from four lower extremity muscles (vastus medialis (VM), medial hamstrings (MH), tibialis anterior (TA), and medial gastrocnemius (MG) during maximal voluntary isometric contractions (MVIC) and during a sensory organization test (SOT) every 30 min over a 4 h simulated workload while wearing ST, TB, and LT footwear. The mean MVIC and the mean and percentage MVIC during each SOT condition from each muscle was analyzed individually using a repeated measures ANOVA at an alpha level of 0.05. Results: Significant differences (p < 0.05) were found for maximal exertions, but this was limited to only the time main effect. No significant differences existed for EMG measures during the SOT. Conclusion: The findings suggest that occupational footwear type does not influence lower extremity muscle activity during both MVIC and SOT. Significantly lower muscle activity during maximal exertions over the course of the 4 h workload was evident, which can be attributed to localized muscular fatigue, but this was not sufficient to impact muscle activity during postural stability tasks.

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