Truncal changes in children with mild limb length inequality: a surface topography study

Abstract

BackgroundLimb length Inequality (LLI) in children and adults may affect posture, gait, and several truncal parameters, and it can cause spinal scoliosis. In literature, however, there is a paucity of assessment of truncal and spinal changes due to mild LLI in children. This report presents children with LLI, and it aims to provide information in pelvic imbalance, spinal posture, and scoliotic curve, using surface topography analysis which is a novel methodological approach for this condition.Study designThis is an ongoing prospective research study on patient series suffering LLI.Material and methodTwenty children, attending the Scoliosis Clinic of the department, 7 boys, 13 girls, 9–15 years old, range 7.5–15, mean 15.5 years, having mild LLI, were assessed. The LLI was 0.5 to 2 cm, mean 1.2 cm. There was not any post-traumatic LLI. We evaluated the LLI in correlation to pelvic and spinal posture parameters. The 4D Formetric DIERS apparatus (4DF) was used for the surface topography assessment. The following were assessed: in the coronal plane, the coronal imbalance, the pelvic obliquity, the lateral deviation, and the 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, the 4DF kyphotic angle, the kyphotic apex, the 4DF lordotic angle, the lordotic apex, the pelvic tilt, and the trunk inclination; and in the transverse plane, the pelvis rotation, the pelvic torsion, the surface rotation, and the 4DF vertebral rotation. LLI was measured using a tape. The data were statistically analyzed, and reliability study for the LLI was also performed.Results/discussionThe LLI was statistically significantly correlated to the 4DF reading of pelvis rotation, pelvic tilt (pelvic obliquity), and surface rotation. The scoliometer readings (angle trunk rotation ATR or trunk inclination ATI) in the lumbar region were statistically significantly correlated to the 4DF readings of pelvic tilt (pelvic obliquity). The normally symmetric truncal parameters were also statistically significantly changed (all these deviating from the line of gravity through the vertebral prominence). Interestingly, LLI was not correlated to the scoliosis angle and the scoliometer reading at the lumbar level.The following 4DF readings are presented: in the coronal plane, the coronal imbalance, pelvic obliquity, lateral deviation, and 4DF scoliosis angle; in the sagittal plane, the sagittal imbalance, kyphotic angle, kyphotic apex, lordotic angle, lordotic apex, pelvic tilt, and trunk inclination; and in the transverse plane, the pelvic rotation, pelvic torsion, surface rotation, and vertebral rotation.ConclusionsPrevious studies have reported the results after simulation of LLI in order to evaluate the effects on the pelvic balance and spinal posture parameters. This report is not a LLI simulation study but it presents the effects of mild LLI on truncal changes in the main cardinal planes in children suffering LLI. These changes undoubtedly affect not only the standing truncal posture but also the gait’s economy as well.As mild LLI affects th...

Indications of sole lift and foot orthoses in the management of mild idiopathic scoliosis—a review

“…There are different types of LLD and scoliosis. LLD can be subdivided into two groups, structural LLD, when there is structural shortening of lower extremity in one side, and functional LLD, which is a result of altered biomechanics of the lower extremity including the pelvis 13) . Likewise, scoliosis can be divided into structural and functional scoliosis, both of which have different biomechanical characteristics.…”

“…Several studies found that LLD is correlated with pelvic tilt in the coronal plane, also called pelvic obliquity 1,2,13,14,[16][17][18] . Some have studied the immediate effects of artificially induced LLDs, using different measuring techniques and showed that LLD affected the pelvic disposition creating pelvic obliquity.…”

“…Some have studied the immediate effects of artificially induced LLDs, using different measuring techniques and showed that LLD affected the pelvic disposition creating pelvic obliquity. Different sizes of sole lifts or elevating platforms were used to induce LLD in healthy participants, including adolescents in one study 13) and a group of healthy soldiers in another 1) to determine their impact on the pelvic disposition. Results were all consistent, increase in sole height elevating ipsilateral pelvis resulted in pelvic obliquity as illustrated in Fig.…”

“…Few studies have intended to show the effects of LLD on pelvic disposition in the transverse plane, or pelvic rotation 13,19) . Grivas et al 13) using Formetric 4D, found that artificially induced LLD was significantly correlated to pelvic rotation, however the compensatory mechanism was not described.…”

Pelvic Symmetry Is Influenced by Asymmetrical Tonic Neck Reflex during Young Children’s Gait

“…The kind of measurement that we proposed was conducted for the first time, so there is no strict comparison with other research. The most common gait analysis is conducted in children with scoliosis or cerebral palsy (CP) or in adults with hemiplegia [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. We have tried to compare some of the results, while keeping cautions.…”