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PubMed1985

Chiropractic concepts of the short leg: a critical review.

There have been relatively few subject areas within the chiropractic profession which have led to such widespread misunderstanding, confusion and controversy. This paper will attempt to examine the research surrounding the development of our current state of understanding concerning the many factors affecting the short leg. Traditionally, research surrounding the short leg has moved in several discreet directions. The first has been toward determining a reliable radiographic method used for measuring structural short legs. Many papers have been published here; included would be the work of Heufelder, Farinet, Giles, Nylander, Manganiello, Marstander, Wettstein, Schilgen and many others. Most tend to center upon use of new instrumentation or use of precise radiographic methods, usually involving femoral head views in some form or other. Another direction the research has taken is into an examination of how the presence of short leg affects biomechanics in both stance and ambulation. Further, investigation here have also centered upon how short leg may alter spinal growth and growth of other bones. I would include here the work of Giles, Pokorna, Moseley, Shapiro, Freiburghaus and Friberg. Other areas of research include diagnosis, therapy and correction. I leave for last a discussion on reliability studies. A major tenant of some chiropractic therapies involves the use of measurement of "functional" short leg. Though procedures for making such measurement are in the public domain, there is no proof within the literature that such exists. There have been done reliability studies attempting to show repeatability of measurement. Results have been mixed at best. I would note here the work of De Boer, Venn and Wakefield, Nichols and others. In all, this is an area under rapid and fairly extensive examination, with a wealth of previous papers available for perusal.

Biomechanical Phenomena↗
PubMed1999

The prevalence of factor V Leiden mutation in patients with leg ulcers and venous insufficiency.

OBJECTIVES: To study the prevalence of factor V Leiden mutation in patients with chronic venous insufficiency and venous leg ulcers, compared with a control group, and to find out whether factor V Leiden mutation is more frequent in patients with chronic venous insufficiency and a history of deep venous thrombosis. DESIGN: A case control study. SETTING: Three outpatient dermatological clinics. PATIENTS: Ninety-two patients (37 men, 55 women) with venous leg ulcers and 53 control patients (23 men, 30 women). MAIN OUTCOME MEASURE: Factor V Leiden mutation. RESULTS: Factor V Leiden mutation was significantly more frequent in patients with chronic venous insufficiency and venous leg ulcers than in the control group (23% vs 7.5%; P=.03), and the patients with factor V Leiden mutation were more likely to have a history of venous thromboembolism (91% vs 48%, P=.002). Also, recurrent deep venous thrombosis (38% vs 14%) and recurrent leg ulcerations (9 episodes or more) occurred more frequently in the patients with factor V Leiden mutation (43% vs 19%, P=.01). No difference was observed in venous refill time or in the presence of dermatoliposclerosis and atrophie blanche. CONCLUSIONS: Factor V Leiden mutation is more frequent in patients with venous leg ulceration than in the control group and the general population. Patients with factor V Leiden mutation have an increased risk of developing deep venous thrombosis and recurrent leg ulceration.

Adult↗
PubMed2003

Arm restlessness as the initial symptom in restless legs syndrome.

BACKGROUND: Upper extremity symptoms can develop in restless legs syndrome, but are rarely the initial symptom. OBJECTIVES: To report a case of restless legs syndrome with restless arms as the initial symptom, and to review the literature. DESIGN: Case report and literature review. PATIENT: A 78-year-old man had arm restlessness and sleep disturbance. A polysomnogram demonstrated subclinical periodic leg movements 1 year after the onset of his symptoms. RESULTS: Two years later, he developed lower extremity symptoms that fit the criteria for restless legs syndrome. To our knowledge, this is the first case of restless legs syndrome with arm restlessness as the initial symptom in an otherwise neurologically normal person. CONCLUSION: Restless legs syndrome may initially exhibit upper extremity symptoms.

Aged↗
PubMed1996

Remodeling of the peripheral processes and presynaptic terminals of leg motoneurons during metamorphosis of the hawkmoth, Manduca sexta.

During metamorphosis of the hawkmoth, Manduca sexta, the muscles, cuticular structures, and most sensory neurons of the larval thoracic legs are replaced by new elements in the adult legs. The thoracic leg motoneurons, however, survive the loss of the larval muscles and persist to innervate new targets in the imaginal legs. Here we have used biocytin staining, immunocytochemistry, and confocal microscopy to follow the fates of the peripheral processes and presynaptic terminals of the leg motoneurons. Although the most distal processes of the motor nerves retract following the degeneration of larval leg muscles, the axon terminals always retain close association with the muscle remnants and the anlagen of the new adult muscles. As the imaginal muscles differentiate and enlarge, the motor terminals expand to form adult presynaptic terminals. An antibody to the presynaptic protein, synaptotagmin, revealed its localization to the terminal varicosities in both larval and adult stages but distribution within pre-terminal branches during adult development. Electrophysiological methods revealed that functional neuromuscular transmission first occurs quite early during metamorphosis, before the differentiation of contractile elements in the muscle fibers.

Animals↗
PubMed1996

Leg proprioceptors of the tobacco hornworm, Manduca sexta: organization of central projections at larval and adult stages.

Organization of the central neuropil of the insect ganglion is characterized in part by a modality-specific layering of afferent projections. This organization has been particularly well described for the central projections of thoracic leg sensory neurons of adult locusts, crickets, and flies. Tactile sensory neurons project into a ventral layer of neuropil, while proprioceptive sensory neurons project into an intermediate layer of neuropil. In order to determine whether a modality-specific layering exists in the CNS of larval Manduca sexta, we have examined the projections of sensory neurons innervating one class of putative proprioceptors, the campaniform sensilla, of the larval metathoracic legs. We find that campaniform sensory neurons of the larval legs have central projection patterns that generally distinguish them from each other and from the tactile sensory neurons. The campaniform projections, however, are not completely segregated from tactile projections in ventral layers of neuropil, as has been described in other insects. By contrast, the projections of campaniform sensory neurons from the adult legs are more extensive and elaborate than their larval counterparts and dramatically different from projections of nearby adult tactile hairs, having extensive arborizations in more dorsal regions of neuropil while those of tactile sensory neurons are restricted to very ventral layers of neuropil. This difference in organization of the afferent projections in larval and adult ganglia may reflect different functions of the leg sensilla and different functions of the legs at the two stages.

Animals↗
PubMed2003

Dressings and topical agents for arterial leg ulcers.

BACKGROUND: It is estimated that people in industrialised countries have a 1% chance of suffering from a leg ulcer at some time in their life. The majority of leg ulcers are associated with circulation problems; poor blood return in the veins causes venous ulcers (around 70% of ulcers) and poor blood supply to the legs causes arterial ulcers (around 25% of ulcers). Treatment of arterial leg ulcers is directed towards correcting the poor arterial blood supply, for example, by surgically correcting arterial blockages, and by supporting ulcer healing using topical agents (medicines in cream/ointment) and wound dressings. There are a large number of topical agents and wound dressings available and it is unclear what impact these have on ulcer healing. OBJECTIVES: To determine whether topical agents and wound dressings affect the rate of healing in arterial ulcers. To compare healing rates, costs and patient-centred outcomes between wound dressings and topical agents. SEARCH STRATEGY: Publications describing (or potentially describing) randomised controlled trials (RCTs), or controlled clinical trials (CCTs) of dressings and topical agents for arterial leg ulcers were sought through the Specialised Trials Registers of the Cochrane Wounds Group (last searched January 2002) and the Cochrane Peripheral Vascular Diseases Group (last searched April 2002). SELECTION CRITERIA: RCTs or CCTs (trials with non-randomised concurrent comparison groups) were eligible for inclusion. The participants had to have ulcers that were described as arterial, and the time to healing, proportion completely healed, or rate of reduction in ulcer area had to be reported. All wound dressings and topical agents were eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: Information on the participants' characteristics, the interventions, and outcomes, as well as data on the trial methods, such as blinding of patients and clinicians, and allocation concealment were extracted using a standardised data extraction form. MAIN RESULTS: One trial met the inclusion criteria. This small trial compared ketanserin ointment with vehicle alone, changed twice a day. The trial was too small and for too short a follow-up period to be able to determine whether there was any difference in healing rates. REVIEWER'S CONCLUSIONS: There is insufficient evidence to determine whether the choice of topical agent or dressing affects the healing of arterial leg ulcers. Inadequate description of the people in the one included trial means that the results cannot be easily applied to other clinical populations.

Administration, Topical↗
PubMed1991

Fibrinolytic activity of the arms and legs of patients with lower limb venous disease.

Clearance of subcutaneous 125I-labelled fibrin was prolonged from the legs but not from the arms of patients with uncomplicated varicose veins and patients with healed ulcers, compared with controls. The euglobulin clot lysis time (ECLT) of blood from the arms and legs of those with healed ulcers was prolonged; venous congestion significantly shortened the ECLT of blood from all limbs except legs with healed ulcers. The clearance of interstitial fibrin of both legs and arms correlated with the response of the ECLT to venous congestion (P less than 0.05). The clearance of interstitial 125I-labelled albumin in five patients with healed ulcers was faster from the legs than from the arms, whereas the clearance of interstitial 125I-labelled fibrin was faster from the arms in all cases. These results suggest that there is a defect in interstitial fibrinolytic activity as well as vein wall production of plasminogen activator in legs with chronic venous insufficiency.

Arm↗
PubMed2006

Leg length, cognitive impairment and cognitive decline in an African-Caribbean population.

BACKGROUND: Shorter leg length is associated with an adverse environment in early childhood and has been found to be associated with a variety of disorders occurring in mid- to late-life, including dementia in a Korean population. In a community population of African-Caribbean elders, in whom leg length had been measured, we sought to compare associations with cognitive impairment at baseline and cognitive decline over a three-year follow-up period. METHODS: Of 290 African-Caribbean residents in south London recruited at baseline, 216 (74%) were re-interviewed after a three-year period and 203 had sufficient data for this analysis. Cognitive impairment was derived as a binary category from a battery of cognitive tests administered at baseline and cognitive decline was derived from change in performance on a subset of these tests. Leg length (iliac crest to lateral malleolus) was also measured. RESULTS: Shorter leg length was associated with female sex, lower occupational social class and reported hypertension and diabetes. Shorter leg length (lowest quartile) was significantly associated with cognitive impairment but there were no apparent associations with cognitive decline. The association with cognitive impairment was independent of age, sex and education. Social class appeared to be an important mediating factor. CONCLUSIONS: Shorter leg length may be a marker of early life stressors which result in reduced cognitive reserve. Interestingly this association was mediated more strongly by social class (previous occupational status) than by education in this population.

Aged↗
PubMed2006

Validation of the "L-DOPA test" for diagnosis of restless legs syndrome.

We developed and validated a standardized test procedure to evaluate the accuracy of the supportive diagnostic criterion "response to dopaminergic treatment" in restless legs syndrome (RLS). Forty-eight patients who fulfilled at least three of the four essential criteria for RLS, thus including uncertain clinical cases for a nonexpert, were recruited. Patients received a preliminary diagnosis of RLS or non-RLS. All patients underwent a polysomnography (PSG) and were then asked to perform the diagnostic L-DOPA test at home, which consisted in the application of one single dose of 100/25 mg L-DOPA/benserazide and a subsequent observational period of 2 hours. Before, and in 15-minute intervals after, drug intake, the patients rated the severity of the "symptoms in the legs" and the "urge to move the legs" using a 100-mm visual analogue scale. Considering a 50% improvement as a positive test result, we found a sensitivity of 88% ("symptoms in the legs") and 80% ("urge to move the legs") with a specificity of 100% for both test items. A rate of 90% or 83% of all patients could be correctly diagnosed by the L-DOPA test. Both scales were able to predict the response to dopaminergic agents in the subsequent course of the treatment by 100%. The periodic leg movements arousal index as assessed by polysomnography was less appropriate for the prediction of the correct diagnosis. We recommend the L-DOPA test for diagnostic decision making in all patients with an unclear RLS diagnosis according to the essential diagnostic criteria of the International RLS Study Group.

Administration, Oral↗
PubMed1996

Unilateral displacement of lower limb evokes bilateral EMG responses in leg and foot muscles in standing humans.

During upright stance, foot dorsiflexion induced by the movement of a supporting platform elicits a short- (SLR) and a medium-latency response (MLR) in both the soleus and the flexor digitorum brevis muscles; foot plantarflexion elicits a MLR in the tibialis anterior. The SLR is the counterpart of the stretch reflex, but no general agreement exists about the origin of the MLR, though recent results suggest that it is transmitted through group II afferent fibres. Animal studies have shown that group II fibres impinge on interneurones projecting contralaterally as well as ipsilaterally, whereas group I fibres impinge on interneurones which project mainly ipsilaterally. Therefore, we compared the changes in amplitude and latency of the SLRs and MLRs in the right and left limb during postural perturbations induced while subjects maintained both feet on the platform (both-on condition) or while they maintained only one foot on the platform and the other on firm ground (one-on condition). Under the both-on condition, the pattern of EMG responses described above occurred bilaterally. Under the one-on condition, both SLRs and MLRs occurred in the displaced leg. However, whereas the SLRs did not change in amplitude compared with the both-on condition, the MLRs decreased in amplitude to about 50%. MLRs were also present in the non-displaced leg. They were not preceded by any SLR but showed a further decrease in size with respect to the corresponding responses in the perturbed leg. Latency of the MLRs of the perturbed leg increased by about 5 ms passing from the both-on to the one-on condition. In the latter condition, a further increase of 5 ms was observed in the nonperturbed leg with respect to the displaced one. The occurrence of the MLRs but not of the SLRs in the contralateral non-displaced leg is in keeping with the notion that crossed neural pathways fed by spindle group II afferent fibres subserve the MLRs. The changes in latency of the MLRs under the one-on condition compared with both-on give a cue about the synaptic delays along the neural circuit and the time taken by the afferent impulses to cross the spinal cord.

Adult↗
PubMed1991

Clinical pharmacokinetics of mitoxantrone in hyperthermic, isolated perfusion of the leg.

The clinical pharmacokinetics of mitoxantrone in hyperthermic, isolated perfusion of the leg were studied in five patients exhibiting solitary, localized malignant melanoma. Mitoxantrone was given as four 1-min infusions at 15-min intervals into the arterial line of the perfusion system at a total dose of up to 14 mg/m2. The mean half-lives for mitoxantrone in the blood circulation of the leg were: t1/2 alpha (distribution phase), 25.5 s, and t1/2 beta (elimination phase), 14.9 min. The mean volume of distribution at steady state in the leg was 25.6 1. In the arterial part of the perfusion, the mean AUC was 155.9 mg min l-1, and that in the corresponding venous part was 91.6 mg min l-1. Leakage of the drug from the leg into the systemic circulation amounted to 1.2% of the total delivered dose; 91% of the delivered dose remained in the leg after the perfusion had been completed. The mean elimination half-life of mitoxantrone in the systemic circulation was 123 min and the corresponding AUC for systemic concentrations was 8.59 mg min l-1. The present data revealed a high uptake of mitoxantrone into the leg and low systemic drug concentrations due to minor leakage, suggesting that mitoxantrone might be a good candidate for use in isolated, hyperthermic limb perfusion.

Adult↗
PubMed1998

[Acute type A aortic dissection with leg ischemia].

The incidence of lower extremity ischemia secondary to acute aortic dissection is relatively low, however, the presenting symptoms are variable in term of severity. We report here in two cases of such circumstances who were successively differently treated. Case one was a 60 years old male presented with severe left leg pain. Even after the initiation of cardiopulmonary bypass, the leg ischemia did not improve, therefore selective leg perfusion was additionally performed through direct left femoral artery cannulation. The surgery toward dissection was completed by mean of simultaneous graft replacement of ascending aorta and aortic arch. The leg ischemia after the aortic procedure however had persisted, femorofemoral bypass was created to relieve the mal-perfusion. Case two was a 37 years old male admitted with severe left leg pain associated with sensory-motor nerve dysfunction with muscle rigidity. In this particular patient, femoro-femoral bypass was firstly reconstructed as the mean of leg salvage procedure. After we learned there was no serious reperfusion symptom manifested, we performed radical surgery toward the aorta. We believe that the decision making of surgical treatment for acute type A dissection complicated with the presence of lower extremity ischemia is based on the severeness of mal-perfusion.

Acute Disease↗
PubMed2001

Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season.

The following possible risk factors for leg injuries in female soccer players were studied: age, anatomical alignment, generalized joint laxity, thigh muscle torque, muscle flexibility, ligamentous laxity of the knee and ankle joints, recent injuries, and duration of soccer exposure. A total of 146 players from 13 teams in the second and third Swedish divisions underwent clinical examination, isokinetic measurements of quadriceps and hamstring torques, and testing of postural sway of the legs. All soccer-related leg injuries resulting in absence from at least one scheduled practice session or game were recorded during one outdoor season (April-October). In 50 players there were 61 traumatic injuries, and 17 players sustained 19 overuse injuries. The overall injury incidence rate (traumatic and overuse) was 5.49/1000 h of soccer. Variables significantly increasing the risk of traumatic leg injuries included generalized joint laxity, low postural sway of the legs, hyperextension of the knee joint, and a low hamstring-to-quadriceps ratio during concentric action. Multivariate logistic regression showed hyperextension of the knee joint, a low postural sway, reduced H/Q ratio during concentric action, and a higher exposure to soccer to significantly increase the risk of traumatic leg injury. All five players who suffered an anterior cruciate ligament injury during the study period had a lower hamstring-to-quadriceps ratio during concentric action on the injured side than on their noninjured side.

Adult↗
PubMed2001

Arm to leg coordination in humans during walking, creeping and swimming activities.

In walking humans, arm to leg coordination is a well established phenomenon. The origin of this coordination, however, remains a matter for debate. It could derive from the intrinsic organisation of the human CNS, but it could also consist of a movement induced epiphenomenon. In order to establish which of these alternatives applies, we recorded arm and leg movements as well as their muscle activities during walking, creeping on all fours and swimming. The relationship between arm and leg cycle frequency observed under these various conditions was then investigated. We found that during walking, creeping on all fours or swimming, arm and leg movements remain frequency locked with a fixed relationship of 1/1, 2/1, 3/1, 4/1 or 5/1. When movements of the legs are slowed by flippers, the frequency relationship may skip to a different value, but the coordination is preserved. Furthermore, minimising the mechanical interactions between the limbs does not abolish coordination. These findings demonstrate that the arm to leg coordination observed in the walking human is also present during other human locomotor activities. The characteristics of this coordination correspond to those of a system of two coupled oscillators like that underlying quadruped locomotion.

Adult↗
PubMedDate not supplied

Pseudocorrection of deviated orthostatic axes on lipodystrophic legs.

reproducible Some lipodystrophies can visually exaggerate the deviation from the axes of the legs. The objective of this work is to demonstrate how an aesthetic operation, such as liposuction, can be used not only to slenderize the leg, bearing in mind the proportions, but also to visually improve the deviations from the referred axis. In other words: aesthetic surgery can be used to pseudocorrect the axis of the legs. The median line of the leg is calculated preoperatively and postoperatively and these curved lines are compared with the axis of the leg. This way, the grade of visual correction can be quantified. This is an easy and reproducible method. Eighty-three cases have been studied with both deviated and lipodystrophic legs.

Adolescent↗
PubMed2001

Differential catabolism of muscle protein in garden warblers (Sylvia borin): flight and leg muscle act as a protein source during long-distance migration.

Samples of flight and leg muscle tissue were taken from migratory garden warblers at three different stages of migration: (1) pre-flight: when birds face an extended flight phase within the next few days, (2) post-flight: when they have just completed an extended flight phase, and (3) recovery: when they are at the end of a stop-over period following an extended flight phase. The changes in body mass are closely related to the changes in flight (P<0.001) and leg muscle mass (P<0.001), suggesting that the skeletal muscles are involved in the protein metabolism associated with migratory flight. From pre- to post-flight, the flight and the leg muscle masses decrease by about 22%, but are restored to about 12% above the pre-flight masses during the recovery period. Biochemical analyses show that following flight a selective reduction occurred in the myofibrillar (contractile) component of the flight muscle (P<0.01). As this selective reduction accounts only for a minor part of the muscle mass changes, sarcoplasmic (non-contractile) and myofibrillar proteins of both the flight and leg muscle act as a protein source during long-distance migration. As a loss of leg muscle mass is additionally observed besides the loss in flight muscle mass, mass change seems not to be strictly associated with the mechanical power output requirements during flight. Whereas the specific content of sarcoplasmic proteins in the flight muscle is nearly twice as high as that in the leg muscle (P<0.001), the specific content of myofibrillar proteins differs only slightly (P < 0.05), being comparably low in both muscles. The ratio of non-contractile to contractile proteins in the flight muscle is one of the highest observed in muscles of a vertebrate.

Adipose Tissue↗
PubMed1994

Instrumental straight-leg raising: results in patients.

Straight-leg raising is used as a diagnostic test for both elastogenic (passive muscle stretch test) and nonelastogenic (Lasègue's test) pathology in patients unable to bend forward from the standing position while holding the knees in extension. The test assessment is based on the range of the leg excursion and the type of pain that is provoked. An instrumental version of Lasègue's test (instrumental straight-leg raising) provides information about the extensibility, elasticity and electrical activity of the hamstrings and back muscles and about pelvic rotation. To investigate the diagnostical value of the additional information, both clinical and instrumental straight-leg raising was done by 30 patients who were unable to touch the ground while bending forward from the standing position with the knees extended. In one group of patients, the electrical activity of the muscles was comparable to that observed in the muscles of a control group of healthy volunteers; in a second group, however, the electrical muscle activity was aberrant. Muscle extensibility and passive muscle elasticity was comparable in patients in the first group and the healthy controls. In the patients with aberrant muscle activity, the elasticity of the passive muscles was not different from the control group, but both leg excursion and muscle extensibility were much smaller. Comparison of the clinically and experimentally diagnosed cause (elastogenic or non-elastogenic) of the movement restriction showed a remarkable discrepancy. We conclude that instrumental straight-leg raising provides valuable additional diagnostical information.

Adolescent↗
PubMed1984

Urinary excretion and efflux from the leg of 3-methylhistidine before and after major surgical operation.

Changes in the effluxes from the leg of 3-methylhistidine and tyrosine were studied in relation to alterations in the 24-hour excretion of 3-methylhistidine and total nitrogen in 11 patients before and after undergoing major surgical operation. On the first day after operation, efflux of 3-methylhistidine from the leg was significantly decreased by 40% compared to preoperative values. In contrast, tyrosine efflux was doubled at the same time as a transient 20% increase in oxygen uptake of the leg and a marked increase in catecholamine excretion were observed. These changes coincided with a 40% elevation in the excretion of both 3-methylhistidine and nitrogen. Leg metabolism returned to the preoperative pattern within a week. These results suggest that the loss of amino acids from the lean tissues of the leg is the result of a fall in protein synthesis accompanied by an adaptive fall in protein breakdown. Although the increase in nitrogen excretion in response to major surgical trauma reflects the negative amino acid balance of skeletal muscle, the changes in urinary 3-methylhistidine do not correlate with changes in efflux of 3-methylhistidine from the leg. These results suggest that the use of 3-methylhistidine excretion as a specific index of skeletal muscle protein breakdown in postoperative patients may be invalid. Tissues other than skeletal muscle appear to make a substantial contribution to the 3-methylhistidine excretion postoperatively.

Adult↗