Distance Between the Malleoli and the Ground

2017 ◽  
Vol 107 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Estela Gomez Aguilar ◽  
Águeda Gómez Domínguez ◽  
Carolina Peña-Algaba ◽  
José M. Castillo-López
Keyword(s):  
Drop Test ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
San Jose ◽  
Leg Length Inequality ◽  
Length Discrepancy ◽  
Navicular Drop ◽  
Tape Measure ◽  
Foot Posture ◽  
The Difference

Background: The aim of this work is to introduce a useful method for the clinical diagnosis of leg-length inequality: distance between the malleoli and the ground (DMG). Methods: A transversal observational study was performed on 17 patients with leg-length discrepancy. Leg-length inequality was determined with different clinical methods: with a tape measure in a supine position from the anterior superior iliac spine (ASIS) to the internal and external malleoli, as the difference between the iliac crests when standing (pelvimeter), and as asymmetry between ASISs (PALpation Meter [PALM]; A&D Medical Products Healthcare, San Jose, California). The Foot Posture Index (FPI) and the navicular drop test were also used. The DMG with Perthes rule (perpendicular to the foot when standing), the distance between the internal malleolus and the ground (DIMG), and the distance between the external malleolus and the ground were designed by the authors. Results: The DIMG is directly related to the traditional ASIS–external malleolus measurement (P = .003), the FPI (P = .010), and the navicular drop test (P < .001). There are statistically significant differences between measurement of leg-length inequality with a tape measure, in supine decubitus, from the ASIS to the internal malleolus, and from the ASIS to the external malleolus. Conclusions: This new method (the DMG) is useful for diagnosing leg-length discrepancy and is related to the ASIS–external malleolus measurement. The DIMG is significantly inversely proportional to the degree of pronation according to the FPI. Conversely, determination of leg-length discrepancy with a tape measure from the ASIS to the malleoli cannot be performed interchangeably at the level of the internal or external malleolus.

Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation

2006 ◽  
Vol 96 (6) ◽  
pp. 499-504 ◽  
Author(s):  
Brian A. Rothbart
Keyword(s):  
Relative Position ◽  
Significant Positive Correlation ◽  
Visual Assessment ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Foot Posture Index ◽  
Posture Index ◽  
Length Discrepancy ◽  
Foot Posture ◽  
Relationship Of

The objective of this study was to determine whether a correlation exists between abnormal pronation and functional leg-length discrepancies. Visual assessment and a pelvic thrust maneuver were used to identify the functionally short leg in 56 indigenous Mexicans (20 males and 36 females; mean age, 33 years; mean weight, 59 kg; and mean height, 1.60 m). The Foot Posture Index was used with a modified stance position to identify the more pronated foot. The posterosuperior iliac spines were used to identify the “relative” position of the innominate bones. The raw data obtained from this study were evaluated using the McNemar test for paired proportions. A significant positive correlation was found between abnormal pronation and hip position and between hip position and functional leg-length discrepancy. These results are consistent with a theoretical ascending dysfunctional pelvic model: Abnormal pronation pulls the innominate bones anteriorly (forward); anterior rotation of the innominate bones shifts the acetabula posteriorly and cephalad (backward and upward); and this shift in the acetabula hyperextends the knees and shortens the legs, with the shortest leg corresponding to the most pronated foot. (J Am Podiatr Med Assoc 96(6): 499-507, 2006)

scholarly journals LEG LENGTH DISCREPANCY;

2013 ◽  
Vol 20 (06) ◽  
pp. 995-998
Author(s):  
HAFIZ MUHAMMAD ASIM, ◽  
AHMAD QAYYUM, ◽  
JAWAD ALI HASHIM,
Keyword(s):  
Standard Deviation ◽  
Treatment Strategies ◽  
Leg Length Discrepancy ◽  
P Value ◽  
Leg Length ◽  
Perfect Agreement ◽  
Length Discrepancy ◽  
Standard Scale ◽  
Tape Measure ◽  
Primary Investigator

Objective: Leg length discrepancy (LLD) has been deemed one of the causative factors for back, sacroiliac conditions andhip pathologies in patients. Increased LLD can exacerbate musculoskeletal impairments in patients that would require the clinician toreflect on the appropriate treatment strategies. The objective of the study was to measure the reliability of “Tape Measure Method” in Leglength discrepancy. Methodology: This is a hospital based study. The procedures for obtaining leg length measures in the study weresimilar to those described by Magee DJ (Orthopedic physical assessment. 5thed).The primary investigator briefly reviewed theprocedures for measuring the leg length with the subjects. Only the subject’s right side was measured for the study. The subject’s weightand height were measured using a standard scale and recorded. The first rater palpated the prominent aspect of the ASIS. The rater thenguided the string to the prominent aspect of the MM. The rater repeated this procedure three times for each subject. After the first raterobtained three strings that correspond to the leg length, the second rater repeated the three measurements using the same procedure.After all cuts of strings were obtained each rater measured the lengths of his three strings with a standard tape measure and was recordedon a separate data sheet. Each rater was blinded to the other measures. Results: Means and standard deviation for each subject’s age,height, weight and BMI were measured. Mean standard deviation and 95% Confidence interval (95% CI) for leg length measurements forboth raters are provided in Table 2. According to the results derived from data there were no significant differences in leg length measuresbetween Rater 1 and Rater 2 (t-value = - 0.000; df = 58; p-value = .9981). The ICC (3, 3) for Rater 1 was .999, (95% CI = .998 to .999).This value indicates almost perfect agreement between the measures for Rater 1. The ICC (3, 3) for Rater 2 was .979 (95% CI = .962 to.990). These findings are indicative of almost perfect agreement between the measures. The ICC (2, 2) between Rater 1 and Rater 2 was.987 (95% CI = .972 to .994). A Bland-Altman plot identifies any bias between the two raters. The bias line is almost on zero, indicating nobias between the two raters. It can be concluded that any observed bias was not clinically important. Conclusions and Discussion: It wasconcluded measuring leg length using the tape measure was simple and highly reliable. There were several limitations that may haveinfluence overall results of the study.

scholarly journals Relationship between leg-length discrepancy and plantar fasciitis

2019 ◽  
Vol 13 (1) ◽  
pp. 77-82
Author(s):  
Henrique Mansur ◽  
Guilherme Gonçalves Feijó Carvalho ◽  
Thiago Coelho Paim Lima ◽  
Cesar Barbosa Gonçalves ◽  
João Luiz Quagliotti Durigan ◽  
...  
Keyword(s):  
Plantar Fasciitis ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
X Ray ◽  
Length Discrepancy ◽  
Foot Posture

Objective: This study evaluated the relationship between leg-length discrepancy (LLD) and plantar fasciitis (PF). Methods: A cross-sectional study was performed that measured the length of the lower limbs via a scanometry of patients with PF. Other risk factors such as body mass index (BMI), foot posture, and the presence of a plantar heel spur on foot X-ray were also evaluated. Results: Of the 54 participating patients, 44.4% were male with a mean age of 50.38 (23-73 years), 81.5% had pain in one foot, and 53.7% had plantigrade feet. We observed LLD in 88.9% of the sample, with a mean discrepancy of 0.749 cm (SD +/-0.63); 46.3% of the painful feet presented with spurs on X-ray. Conclusions: Approximately 90% of the patients presented with LLD, and the shorter limb was the affected side in most cases. Level of Evidence II; Prognostic Studies.

Comparison of Lifts Versus Tape Measure in Determining Leg Length Discrepancy

2014 ◽  
Vol 41 (8) ◽  
pp. 1689-1694 ◽  
Author(s):  
Maziar Badii ◽  
A. Nicole Wade ◽  
David R. Collins ◽  
Savvakis Nicolaou ◽  
B. Jacek Kobza ◽  
...  
Keyword(s):  
Interobserver Reliability ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Length Discrepancy ◽  
Tape Measure ◽  
Pelvic Radiograph ◽  
Clinical Methods

Objective.To evaluate the validity (accuracy) and reliability of 2 commonly used clinical methods, 1 indirect (lifts) and 1 direct (tape measure), for assessment of leg length discrepancy (LLD) in comparison to radiograph.Methods.Twenty subjects suspected of having LLD participated in this study. Two clinical methods, 1 direct using a tape measure and 1 indirect using lifts, were standardized and carried out by 4 examiners. Difference in height of the femoral heads on standing pelvic radiograph was measured and served as the gold standard.Results.The intraclass correlation coefficient assessing interobserver reliability was 0.737 for lifts and 0.477 for tape measure. The remainder of the analysis is based on the average of the measurements by the 4 examiners. Pearson correlation coefficients were 0.93 for the lifts and 0.75 for the tape measure method. Paired sample t tests showed difference in means of 2 mm (p = 0.051) for lifts and −5 mm (p = 0.007) for tape measure compared with radiograph. Sensitivity and specificity were 55% and 89% for lifts and 45% and 56% for tape measure, respectively, using > 5 mm as the definition for LLD. The wrong leg was identified as being shorter in 1 out of 20 subjects using lifts versus 7 out of 20 using tape measure.Conclusion.The indirect standing method of LLD measurement using lifts had superior validity, interobserver reliability, and specificity in comparison with radiograph over the direct supine method using tape measure. Both clinical methods underestimated LLD compared with radiograph.

scholarly journals Patient’s perception on leg length discrepancy after total hip arthroplasty in patients with unilateral Crowe type IV developmental dysplasia of the hip

2020 ◽  
Author(s):  
Yinqiao Du ◽  
Junmin Shen ◽  
Jingyang Sun ◽  
Chi Xu ◽  
Ming Ni ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Developmental Dysplasia ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Total Hip ◽  
Length Discrepancy ◽  
Type Iv ◽  
The Difference ◽  
Dysplasia Of The Hip

Abstract Background: The study assessed the correlation among the patients’ perception on leg length discrepancy (LLD) after total hip arthroplasty (THA) in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH) and the four methods of measuring the leg length in the full-length standing anteroposterior radiographs. Methods: 60 patients with unilateral Crowe type IV DDH were recruited in this retrospective study between January 2012 and January 2019. Four methods of measurement were used: (1) TD-TP: distance between the inferior aspect of teardrop and the midpoint of tibial plafond (TP). (2) CH-TP: distance between the center of femoral head or acetabular cup and the TP. (3) GT-TP: distance between the apex of greater trochanter and the TP. (4) FL + TL: the sum of femoral length and tibial length. Results: Association was found among the patients’ perception on LLD with difference in TD-TP (OR, 1.157), and the difference in FL + TL (OR, 1.166). The area under the curve of the difference in FL + TL and the difference TD-TP (0.704 and 0.679) was significantly higher than those of the difference in CH-TP and the difference in GT-TP (0.564 and 0.483). With the calculated threshold of LLD set at 9.0 mm, the sensitivity and specificity of the difference in TD-TP and the difference in FL + TL were 57.7%, 79.4% and 61.5%, 79.4%, respectively.Conclusion: Patients’ perception on LLD had good correlation and reliability on the difference of FL + TL and the difference of TD-TP.

scholarly journals Does the intra-operatively measured leg length correction compare to the post-operative radiograph in total hip replacement surgery?

2020 ◽  
Author(s):  
Z Moonda ◽  
MB Nortje ◽  
R Dey
Keyword(s):  
Total Hip Replacement ◽  
Measurement System ◽  
Hip Replacement ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Total Hip ◽  
Length Discrepancy ◽  
Radiographic Measurements ◽  
Absolute Residual ◽  
The Difference

ABSTRACT BACKGROUND: This study aims to analyse the accuracy of the Vertical Measurement System™ (VMS) in assessing the leg length correction (LLC) during total hip arthroplasty (THA) by comparing the intra-operative measurements to the radiographic measurements obtained six weeks post-operatively Patients and methods: A prospective cohort study was conducted in which patients undergoing primary THA were enrolled at two centres in Cape Town, over a period of 19 weeks. THAs were performed by four surgeons. Pre-operative leg length discrepancy (LLD) measurements were obtained in 92 patients. The VMS was used to predict intra-operative LLC, and this measurement was compared to the post-operative LLC measured on the six-week follow-up X-ray. These measurements were statistically compared using the Mann-Whitney U test. RESULTS: The difference between the intra-operative VMS calculation and the six-week radiological measurement was not significant (p>0.05), with the difference in their mean values being 0.1±3.3 mm. In the cohort, 82% of the patients (n=75) were within 5 mm of the target LLC, and 96% of patients (n=88) were within 10 mm of the target LLC. The mean absolute residual LLD at six weeks was 3.2±3.1 mm. CONCLUSION: The intra-operative LLC measurement obtained using the VMS accurately predicts the six-week post-operative radiographic LLC measurement Level of evidence: Level 4 Keywords: total hip replacement, leg length discrepancy, leg length correction, vertical measurement system, comparative study, longitudinal study

scholarly journals Correlation between Gait Asymmetry and Leg Length Discrepancy—What Is the Role of Clinical Abnormalities?

2018 ◽  
Vol 8 (10) ◽  
pp. 1979 ◽  
Author(s):  
Sam Khamis ◽  
Barry Danino ◽  
Dror Ovadia ◽  
Eli Carmeli
Keyword(s):  
Lower Limb ◽  
Pearson Correlation ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Random Forest Classification ◽  
Length Discrepancy ◽  
Forest Classification ◽  
The Difference ◽  
Joint Center ◽  
The Impact

Reducing the effect of leg length discrepancy (LLD) on gait abnormalities while other abnormal conditions such as spasticity, joint contractures or weak muscle strength are exhibited is challenging. This study aimed to evaluate the impact of mild LLD on lower limb biomechanics, on participants with anatomic LLD with and without other clinical abnormalities. A motion capture system was utilized on 32 participants to measure lower limb kinematics and dynamic leg length (DLL) throughout the gait cycle, calculated as the absolute distance from the hip joint center, either to the heel, ankle joint center, or forefoot. The Pearson correlation coefficient found that LLD was associated with 5 kinematic variables only when LLD appeared with no other clinical abnormalities present (r = 0.574 – 0.846, p < 0.05). When clinical abnormalities were present, the random forest classification accuracy was lower (64% versus 80%), implying that the used kinematics are low predictors for anatomic LLD, revealing a higher asymmetrical clearance index (the difference between the maximal stance phase and the minimal contra-lateral swing phase DLL) and a different kinematic variable importance index. Clinical abnormalities in pathological gait will in all probability significantly affect gait deviations, affirming mild anatomic LLD as inconsequential. A functional measurement can offer a better estimate as to the side and extent of the functional discrepancy.

Changes in patient-perceived leg length discrepancy following total hip arthroplasty

2021 ◽  
Author(s):  
Kentaro Iwakiri ◽  
Yoichi Ohta ◽  
Takashi Fujii ◽  
Yukihide Minoda ◽  
Akio Kobayashi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Leg Length Discrepancy ◽  
Leg Length ◽  
Total Hip ◽  
Length Discrepancy
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