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Overview
Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural - when the difference occurs in bone structures - or functional, because of mechanical changes at the lower limbs. The discrepancy can be also classified by its magnitude into mild, intermediate, or severe. Mild LLD has been particularly associated with stress fracture, low back pain and osteoarthritis, and when the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these orthopaedic changes may appear early and severely. The aim of this study was to analyze and compare ground reaction force (GRF) during gait in runners with and without mild LLD. Results showed that subjects with mild LLD of 0.5 to 2.0 cm presented higher values of minimum vertical GRF (0.57 ? 0.07 BW) at the shorter limb compared to the longer limb (0.56 ? 0.08 BW) Therefore, subjects with mild LLD adopt compensatory mechanisms that cause additional overloads to the musculoskeletal system in order to promote a symmetrical gait pattern as showed by the values of absolute symmetric index of vertical and horizontal GRF variables.Leg Length Discrepancy

Causes
The causes of LLD are many, including a previous injury, bone infection, bone diseases (dysplasias), inflammation (arthritis) and neurologic conditions. Previously broken bones may cause LLD by healing in a shortened position, especially if the bone was broken in many pieces (comminuted) or if skin and muscle tissue around the bone were severely injured and exposed (open fracture). Broken bones in children sometimes grow faster for several years after healing, causing the injured bone to become longer. Also, a break in a child?s bone through a growth center (located near the ends of the bone) may cause slower growth, resulting in a shorter extremity. Bone infections that occur in children while they are growing may cause a significant LLD, especially during infancy. Bone diseases may cause LLD, as well; examples are neurofibromatosis, multiple hereditary exostoses and Ollier disease. Inflammation of joints during growth may cause unequal extremity length. One example is juvenile rheumatoid arthritis. Osteoarthritis, the joint degeneration that occurs in adults, very rarely causes a significant LLD.

Symptoms
Often there are few or no symptoms prior to the age of 25-35. The most common symptom is chronic lower back pain, but also is frequently middle and upper back pain. Same-sided and repeated injury or pain to the hip, knee and/or ankle is also a hallmark of a long-standing untreated LLD. It is not uncommon to have buttock or radiating hip pain that is non-dermatomal (not from a disc) and tends to go away when lying down.

Diagnosis
Infants, children or adolescents suspected of having a limb-length condition should receive an evaluation at the first sign of difficulty in using their arms or legs. In many cases, signs are subtle and only noticeable in certain situations, such as when buying clothing or playing sports. Proper initial assessments by qualified pediatric orthopedic providers can reduce the likelihood of long-term complications and increase the likelihood that less invasive management will be effective. In most cases, very mild limb length discrepancies require no formal treatment at all.

Non Surgical Treatment
People with uneven leg lengths may be more prone to pain in their back, hips, and knees; uneven gait; and lower leg and foot pain diagnosis (http://maurinekirscht.hatenablog.com/) problems. Due to its risks, surgery is typically not recommended unless the difference is greater than one inch. In cases where the difference is less than one inch, providing the same support for both feet is the most effective. This can be achieved by getting custom-fitted orthotics for both feet. Orthotics are inserts that you wear in the shoes. Your chiropractor will request to measure your feet and possibly your legs. You can step on a device that will take the measurements or you might have a plaster cast of your feet taken. Orthotics are typically made from plastic and leather, and function biomechanically with your foot. If a leg length discrepancy is not properly corrected with orthotics, your chiropractor may recommend a heel lift, also known as a shoe lift. You simply place it in the back of your shoe along with the orthotic. Typically, you will only wear the heel lift in one shoe to assist the shorter leg.
LLD Shoe Inserts
Surgical Treatment
Surgical treatments vary in complexity. Sometimes the goal of surgery is to stop the growth of the longer limb. Other times, surgeons work to lengthen the shorter limb. Orthopedic surgeons may treat children who have limb-length conditions with one or a combination of these surgical techniques. Bone resection. An operation to remove a section of bone, evening out the limbs in teens or adults who are no longer growing. Epiphyseal stapling. An operation to slow the rate of growth of the longer limb by inserting staples into the growth plate, then removing them when the desired result is achieved. Epiphysiodesis. An operation to slow the rate of growth of the longer limb by creating a permanent bony ridge near the growth plate. Limb lengthening. A procedure (also called distraction osteogenesis or the Ilizarov procedure) that involves attaching an internal or external fixator to a limb and gradually pulling apart bone segments to grow new bone between them. There are several ways your doctor can predict the final LLD, and thus the timing of the surgery. The easiest way is the so-called Australian method, popularised by Dr. Malcolm Menelaus, an Australian orthopedic surgeon. According to this method, growth in girls is estimated to stop at age 14, and in boys at age 16 years. The femur grows at the rate of 10 mm. a year, and the upper tibia at the rate of 6 mm. a year. Using simple arithmetic, one can get a fairly good prediction of future growth. This of course, is an average, and the patient may be an average. To cut down the risk of this, the doctor usually measures leg length using special X-ray technique (called a Scanogram) on three occasions over at least one year duration to estimate growth per year. He may also do an X-ray of the left hand to estimate the bone age (which in some cases may differ from chronological age) by comparing it with an atlas of bone age. In most cases, however, the bone age and chronological age are quite close. Another method of predicting final LLD is by using Anderson and Green?s remaining growth charts. This is a very cumbersome method, but was till the 1970?s, the only method of predicting remaining growth. More recently, however, a much more convenient method of predicting LLD was discovered by Dr. Colin Moseley from Montreal. His technique of using straight line graphs to plot growth of leg lengths is now the most widely used method of predicting leg length discrepancy. Whatever method your doctor uses, over a period of one or two years, once he has a good idea of the final LLD, he can then formulate a plan to equalize leg lengths. Epiphyseodesis is usually done in the last 2 to 3 years of growth, giving a maximum correction of about 5 cm. Leg lengthening can be done at any age, and can give corrections of 5 to10 cm., or more.



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:: برچسب ها : foot pain dehydration , foot pain after sitting , foot pain cures ,
تاريخ : سه شنبه 24 مرداد 1396 | 10:00 | نویسنده : Katherina Gorecki |
Overview
Heel Discomfort
Heel pain is often a symptom caused by one of two conditions: Plantar Fasciitis or Achilles Tendonitis. Most commonly, heel pain experienced at the bottom of the heel is caused by plantar fasciitis. Heel pain may become so severe for some that just putting weight on their feet first thing in the morning is excruciating. Walking or running may feel completely out of the question.

Causes
some heel pain can be caused by rheumatological diseases, and these pains can do a real good impersonation of plantar fasciitis symptoms. Seronegative Arthropathies such as Psoriatic Arthritis, Reactive Arthritis and Ankylosing Spondylisis are the most common types to cause heel pain by producing an inflammatory reaction where the fascia attaches to the heel. This is called an enthesitis. If you have a history of Psoriasis or a family history of other arthritic conditions listed above we recommend you see a clinician about your heel pain to confirm the diagnosis. Another occasional cause of heel pain is loss of the cushioning fat pad of the heel, which can result in a bruised heel bone (calcaneus). If you can easily feel your heel bone through your skin on the bottom of your foot you may well have poor fatty tissue on your heel. Pressing on the centre of your heel should feel like pushing into firm rubber, and your skin should not move easily. If you can pinch the skin under your heel and feel a very hard lump when you press the bottom of your heel then it is likely you have a heel fat pad problem. One simple final test is to walk on a hard floor. If you feel the pain only when your heel hits the ground a fat pad problem is most likely. If the pain mainly occurs as you lift the heel off the ground it is more likely to be plantar fasciitis.

Symptoms
The symptoms of plantar fasciitis include pain along the inside edge of the heel near the arch of the foot. The pain is worse when weight is placed on the foot especially after a long period of rest or inactivity. This is usually most pronounced in the morning when the foot is first placed on the floor. This symptom called first-step pain is typical of plantar fasciitis. Prolonged standing can also increase the painful symptoms. It may feel better after activity but most patients report increased pain by the end of the day. Pressing on this part of the heel causes tenderness. Pulling the toes back toward the face can be very painful.

Diagnosis
Depending on the condition, the cause of heel pain is diagnosed using a number of tests, including medical history, physical examination, including examination of joints and muscles of the foot and leg, X-rays.

Non Surgical Treatment
Initial treatment should consist of an ice pack. Some runners prefer to use a wet towel that has been in the fridge. We recommend you use commercially available ice packs for focused pain released. An anti-inflammatory such as Ibuprofen will help to reduce the swelling. Please note this should be taken with meals and never before running. As with all soft tissue injuries, you may have to re-examine your training regime. A reduction or even a total break form running may be necessary. . Examine your running shoes, making sure the shoes do not bend excessively near the middle of the foot and at the ball of the foot. Sports shoes with built in insoles can be beneficial, however we recommend you replace existing insoles with specific sports orthotics/ insoles. Silicone heel cups, leather heel pads and contrasting cold and hot therapy can all help to speed up the healing process. The plantar fascia stretch will help to prevent the injury from occurring again. Please note that this stretch should not be done while the heel is inflamed and should only be attempted once you?re a feeling minimal or no pain from your heel.

Surgical Treatment
Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).

Prevention
Foot Pain
It may not be possible to prevent all cases of heel pain. However, there are some easy steps that you can take to avoid injury to the heel and prevent pain. Whenever possible, you should wear shoes that fit properly and support the foot pain in the arch (http://freddaarizzi.hatenablog.com/archive/2015/08/25), wear the right shoes for physical activity, stretch your muscles before exercising, pace yourself during physical activity, maintain a healthy diet, rest when you feel tired or when your muscles ache, maintain a healthy weight.



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:: برچسب ها : foot pain big toe , foot pain by arch , foot pain map ,
تاريخ : شنبه 21 مرداد 1396 | 12:50 | نویسنده : Katherina Gorecki |