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At least 1,009 records · Page 56Linked to original sources
PubMed2001

Management of leg length inequality.

Leg length inequality is common. Treatment objectives include obtaining leg length equality, producing a level pelvis, and improving function. Clinical assessment should include determination of a level pelvis with the patient standing using a set of blocks of various heights to estimate the amount of leg length inequality. Radiographic measures include the teleroentgenogram, orthoradiograph, and computed tomography (CT). A prediction of the ultimate leg length inequality at skeletal maturity will be needed to determine treatment. Our guidelines for treatment of leg length inequality are as follows: <2 cm--no treatment or a lift in the shoe; 2 to 6 cm--an epiphysiodesis or shortening procedure is considered; 6 to 15 cm--a lengthening procedure is considered. A leg length inequality of 15 to 20 cm--may require a staged lengthening, lengthening combined with epiphysiodesis, or amputation. Numerous complications of limb lengthening procedures occur frequently, even in experienced hands.

Bone Lengthening↗
PubMed2002

High resolution unenhanced computed tomography in patients with swollen legs.

PURPOSE: To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs. MATERIAL AND METHODS: CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primary lymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement. RESULTS: Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema. CONCLUSION: Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.

Adolescent↗
PubMed2003

Knowledge and attitudes regarding care of leg ulcers. Survey of family physicians.

OBJECTIVE: To determine family physicians' perceptions of and attitudes toward leg ulcer care and awareness of effective treatments for venous leg ulcers. DESIGN: Self-administered, cross-sectional faxed and mailed survey. SETTING: Ottawa-Carleton, Ont. PARTICIPANTS: All physicians in the region who were members of the College of Family Physicians of Canada. RESULTS: Response rate was 62%. During 1 month, 107 physicians reported having 226 patients with leg ulcers; only a few patients had had ultrasound assessment. Few physicians (16%) were confident about managing leg ulcers; 61% reported not knowing enough about wound-care products. More than 50% were unaware that compression is effective treatment for venous ulcers. Problems reported were lack of evidence-based clinical practice guidelines for leg ulcer care (82%); absence of evidence-based protocols in home-care agencies (72%); lack of access to wound-care products (69%) and wound-care centres (66%); and poor communication among health care workers (60%). CONCLUSION: Better access to diagnostic assessments and use of compression therapy for venous leg ulcers would improve care.

Bandages↗
PubMed1992

A comparative analysis of transcutaneous oximetry (tcPO2) during oxygen inhalation and leg dependency in severe peripheral arterial occlusive disease.

Transcutaneous oximetry (tcPO2) performed during either oxygen inhalation or leg dependency was intra-individually compared in 64 patients suffering from a peripheral arterial occlusive disease, with and without critical limb ischemia. Among the 81 extremities investigated, 29 had a moderate peripheral arterial occlusive disease (6 in stage I, 23 in stage II) and 52 were initially affected by rest pain or ulceration (stage III/IV). Thirty-seven legs out of the latter improved under conservative treatment. In the remaining 15 limbs, vascular surgery or an amputation became necessary. The tcPO2 was measured at the forefoot with the patient in supine and sitting positions while breathing room air and in the supine position while inhaling 100% oxygen. In limbs with a tcPO2 below 15 mm Hg of patients in the supine position breathing room air, leg dependency generally provoked larger tcPO2 increases than oxygen inhalation. This difference between oxygen inhalation while supine and room air breathing leg dependency tcPO2 values exhibited an approximately linear correlation with the resting tcPO2. Responses of tcPO2 to leg dependency and oxygen inhalation seemed to reflect different mechanisms, that is, microvascular flow redistribution and supine perfusion reserve, respectively. The best discrimination of critical limb ischemia was observed for the tcPO2 of patients breathing room air while in the supine position, which was not surpassed by either the oxygen inhalation or the leg dependency test. Satisfactory results were achieved by combining limits for, first, supine (10 mm Hg) and sitting (45 mm Hg) tcPO2, as well as, second, ankle arterial pressure (60 mm Hg) and supine tcPO2 (10 mm Hg).

Adult↗
PubMed2006

[Diagnosis and treatment of gluteal muscle contracture associated with unequal leg length caused by pelvis obliquity].

OBJECTIVE: To investigate the pathogenesis, diagnosis, and treatment of the gluteal muscle contracture associated with an unequal leg length caused by the pelvis obliquity (GMC-PO). METHODS: The retrospective analysis was made on the clinical features and the follow-up results in 132 patients who had been admitted from January 1990 to December 2004 for GMC-PO. Among them, 73 were male and 59 were female with a range in age from 5 to 26 years (average, 11 yr). All the patients were characterized by unsymmetrical contracture of the gluteal muscles, including unilateral and bilateral contracture. Of the patients, 89 had a clear limping and 78 had a clearly-unequal leg length. The X-ray examination revealed pelvis obliquity in 97 cases and an increased angle of the femur neck in 11 cases. The arc longitudinal incision was made into the posterolateral area nearby the greater trochanter and then lysis of the gluteal muscles was performed, combined with the skin traction of both legs and exercise training. RESULTS: Of the 132 patients with unequal gluteal muscle contracture before operation, 13 had a relative length difference of 0.5-1.5 cm between the 2 legs, 1 had a difference of 3.0 cm, and the remaining 118 patients had an equal leg length. Excellent and good results were achieved in 118 and 13 patients, respectively after the surgical release of the gluteal muscle contracture by the arc longitudinal incision into the posterolateral area nearby the greater trochanter, combined with postoperative skin traction and functional exercises. Only 1 patient had a poor result. The follow-up for 3 months to 14 years showed that the cure rate was as high as 99.2%. CONCLUSION: The gluteal muscle contracture associated with an unequal leg length caused by the pelvis obliquity is a result of the unequal gluteal muscle contracture between the 2 hips and it can be cured with a comprehensive therapeutic method including the surgical release of the gluteal muscle contracture by the are longitudinal incision into the posterolateral area nearby the greater trochanter, and postoperative skin traction as well as the functional exercise.

Adolescent↗
PubMed2006

A simple and accurate method for determining leg length in primary total hip arthroplasty.

Reconstruction of appropriate leg length is an important part of soft-tissue balance in total hip arthroplasty (THA). Leg length discrepancy (LLD) is one of the more common reasons for litigation after otherwise successful THA. The purpose of the study reported here was to analyze the accuracy of using preoperative templating and intraoperative referencing of the well leg to determine postoperative leg length in unilateral primary THA. Seven-hundred primary THAs performed at an institution by 3 surgeons were randomly selected from a computerized database. Cases with significant bilateral disease, congenital dysplasia, acute fracture, or previous surgery or without complete preoperative and postoperative radiographs were excluded. Three reviewers used a standardized method to measure preoperative and postoperative LLD. Included in the review were 410 THAs. Mean postoperative LLD was 3.9 mm lengthening (SD, 7.5 mm). In 20 THAs (4.9%), lengthening was more than 15 mm. Lengthening was more than 20 mm (maximum, 22 mm) in 4 THAs (1%). Of the 20 THAs with LLD of more than 15 mm, 14 involved hips that were longer preoperatively. Thirteen of these hips were reconstructed to within 10 mm of preoperative LLD. Only 2 patients with radiographic LLD of more than 15 mm perceived LLD. There were no differences in gender, height, weight, or body mass index. This method of preoperative templating and referencing the well leg intraoperatively is an inexpensive, reliable, and accurate method for determining leg length in primary THA and has few significant radiographic or clinical outliers.

Arthroplasty, Replacement, Hip↗
PubMed1991

Instrumental straight-leg raising: a new approach to Lasègue's test.

In clinical practice the outcome of Lasègue's test is interpreted with respect to two variables: (1) the maximum angle between the leg and the horizontal plane to which the leg can be lifted, and (2) the pain that is provoked by the movement. For a number of reasons it is difficult in many patients to interpret the test outcome; predominantly, it is because of the lack of information it yields concerning the activity of the muscles. To get more information, an instrumental test was developed that imitates Lasègue's test. In this setup, which is based on a simple biomechanical model, the leg is passively raised in a lift installation. During lifting, the angles between leg and horizontal plane and between leg and pelvis are measured with electrogoniometers; the lift moment is determined with the help of a force transducer; pelvic rotation is assessed with a lordosis meter; and surface electromyography is used to record electric transducer; pelvic rotation is assessed with a lordosis meter; and surface electromyography is used to record electric activity in the erector spinae, the gluteus maximus, and the semimembranosus. The method, called instrumental straight-leg raising, makes it possible to determine the extensibility, elasticity, and electric activity of the hamstrings and back muscles during Lasègue's test. This information provides a better basis for the interpretation of the test outcome.

Adult↗
PubMed1989

A comparative study of ciprofloxacin and conventional therapy in the treatment of patients with chronic lower leg ulcers infected with Pseudomonas aeruginosa or other gram-negative rods.

Twenty-six elderly patients with chronic leg ulcers infected by Pseudomonas aeruginosa or other aerobic Gram-negative rods were randomised to two treatment groups. The control group (eight patients) received conventional local therapy and the other group (18 patients) was treated with oral ciprofloxacin for three months in addition to conventional local therapy. In the beginning of the study both groups were comparable with the age of the patients and the associated diseases including impairment of arterial and venous circulation in the lower legs. Also the size, duration and the severity of the inflammation reaction in the leg ulcers were comparable before the start of the therapy. Ciprofloxacin was clinically more effective than the standard therapy in reducing the size of the ulcer (p less than 0.05). Also the need of extra systemic antibiotics decreased significantly in the ciprofloxacin group compared with the controls. In three out of eighteen ciprofloxacin treated patients the leg ulcers disappeared completely during the three months' study period compared with none in the control group. However, ciprofloxacin resistant strains, mainly staphylococci, appeared in the leg ulcers in 67% of the ciprofloxacin treated patients compared with 0% in the control group (p less than 0.01). No significant side-effects due to ciprofloxacin except the resistant strains were noticed. We conclude that oral long-term ciprofloxacin therapy is effective in the treatment of chronic leg ulcer infections due to Gram-negative rods but selection of ciprofloxacin resistant strains is a problem in this patient group.

Administration, Oral↗
PubMed1988

[Covering losses of cutaneous substance of the leg and foot using skin flaps. Apropos of 76 cases].

Between 1983 and 1987, 76 flap grafts were performed in the leg and foot. In general, 3 types of flap were used: --51 ipsilateral flaps, the majority of which were musculo-cutaneous flaps from the medial head of gastrocnemius (17 cases). --17 cross-leg flaps from the opposite limb, the majority of which were medial fascio-cutaneous flaps (13 cases). --8 free flaps, making use of microsurgical techniques. The indications for cross-leg flaps and free flaps have become more limited in favour of local regional pedicle flaps. The lower part of the leg and amputation stumps in the foot are easily covered by distal leg pedicle flaps and amputation stumps of the upper third of the leg can be covered by a flap of fascia lata with a distal pedicle based on the superolateral branches of the peri-articular plexus of the knee.

Cicatrix↗
PubMed1987

Exercise and smoking habits in patients with and without low back and leg pain.

The exercise and smoking habits of low back or leg pain sufferers vs. persons not having low back or leg pain are compared. The type, frequency and length of exercise is determined from a study of 576 low back or leg pain sufferers compared to 50 persons who state they are symptomatic. The same was done for smoking habits. Thirty-three percent of low back or leg pain sufferers smoked as compared to 14% of those without pain. Forty-seven percent of low back or leg pain sufferers as compared to 86% of non-sufferers exercised regularly. The level of physical activity and general exercise have been found to improve strength, mobility and endurance; this might prevent future back injury. Our study is to determine differences in the exercise habits of persons with low back and/or leg pain vs. those who do not have pain, with the intention being to see if pain sufferers exercise less.

Back Pain↗
PubMed1988

[Regional blood flow and oxygen consumption in the leg muscles of normal subjects and in those with arterial insufficiency. Study of the distribution of C15O2 and of 15O2 using positron emission tomography].

We first studied the distribution of radioactivity during continuous inhalation of C15O2 and 15O2 in traverse tomograms of the greatest diameter of legs, at rest and immediately after exercise (ankle flexions). C15O2 and 15O2 were distributed homogeneously and symmetrically in both legs of normal subjects at rest. The activity accumulated in the anterolateral region after exercise. In patients, this pattern of distribution was similar but asymmetrical, depending on the arterial pathology. No systematic distribution of either C15O2 or 15O2 was observed. In a second step, we studied quantitatively blood flow (F), oxygen uptake (R) and oxygen extraction (E) in 11 subjects: 5 normals (23 +/- 1 years) and 6 patients (60 +/- 11 years) suffering from unilateral intermittent claudication. We used the bolus inhalation technique of C15O2 and 15O2. In the normal leg at rest, ranges were 2.5 to 8.0 ml/min.hg for F, 0.9 to 21.3 mumol/min.hg for R and 3.6 to 33.4% for E. In the pathological leg at rest, ranges were 3.7 to 11.3 ml/min.hg for F, 3.8 to 10.6 mumol/min.hg for R and 7.1 to 24.5% for E. After exercise, ranges were 6.4 to 62.8 ml/min.hg for F, 66.0 to 386.3 mumol/min.hg for R and 29.2 to 89.5% for E in both legs. There was no straight difference between normal and pathological legs soon after exercise. This study allows us to expect that the demonstration of such a difference implies a longer delay of data acquisition following the slow post-ischemia recovery.

Adult↗
PubMed1987

Short leg correction: a clinical trial of radiographic vs. non-radiographic procedures.

Visual leg length insufficiency detection and correction is compared with established radiographic procedures on 41 consecutive patients presenting to a chiropractic clinic with low back pain. It is commonly accepted that the most accurate procedure of short leg demonstration is the standing X ray. Visual correction, as described by Rene Cailliet, uses three anatomical points of reference: a) iliac crest levelness, b) vertical appraisal of the spine from the sacral base (the spine should be perpendicular to the sacral base) and c) levelness of the posterosuperior iliac spine (PSIS) dimples. Lifts of varying thickness were placed under the foot of the short leg in both leg length corrective procedures. This study found that the visual method of measurement did not differ significantly from the X-ray method of measurement for leg length insufficiency. Further, it was found that when comparing those in which the visual measure was less than the X-ray measure and those in which the visual measure was greater, there was a significant relationship between visual and X-ray measures. Eta (eta 2) demonstrates that there is a very strong relationship between visual and X-ray methods of measurement. A review of the literature is presented regarding the correlation of leg length insufficiency and musculoskeletal disorders, as well as the discrepancy required to alter biomechanical properties of the trunk and lower extremity.

Analysis of Variance↗
PubMed1985

[Blood flow changes in the legs of patients with disc herniation and spinal canal stenosis].

Blood flow changes through the leg were examined by thermography, heated thermocouple technique and straingauge plethysmography in patients with lumbar-disc herniation and spinal canal stenosis. Hypothermal areas were observed in the affected leg in disc herniation and of both legs in spinal canal stenosis. An increased blood flow through the anterior tibial muscle during sustained contraction was slightly depressed, and post-contraction hyperemia showed an increase in amount and duration in disc herniation. Levels of resting arterial inflow through the leg were almost half that of healthy individuals, and reactive hyperemia after walking revealed a marked prolongation especially in spinal canal stenosis. In postoperative cases of spinal canal stenosis the thermogram and arterial inflow of the leg returned to their normal level. These results can provide evidence of latent ischemia of the leg that may be caused by a radicular or sympathetic dysfunction in the lumbar spinal diseases.

Adult↗
PubMedDate not supplied

Assessment of transcutaneous oxygen tension in ischaemic legs by means of using an electric blanket and 40% O2.

This work was done to evaluate the transcutaneous oxygen tension (TcPO2) in ischaemic legs introducing two variables: O2 breathed at 40% and heating with an electric blanket (HEB). Forty nine legs were studied and divided into three different groups: Normal (N) 19 legs, Intermittent Claudication (IC) 12, and Rest Pain (RP) 13. The transcutaneous sensor was placed on the Anterior Chest Wall (AChW), High thigh (HT), Anterior Tibial Compartment (ATC) and Dorsum of the Foot (DF). Measurements were done at each area with and without 40% O2 and with and without HEB. The TcPO2 readings increased significantly (P less than 0.05) in the three groups (N, IC, RP) at all leg levels (HT, ATC, DF) when the patient breathed 40% O2 with and without HEB. In the N group no significant differences were noted between the three leg levels whether the 40% O2 or the HEB was used or not (P less than 0.05). In the RP group significant differences were obtained when the HEB was used whether the patient was breathing ambient O2 or at 40%. On the contrary, when the HEB was not used, the differences between HT and ATC disappeared but persisted at the DF (P less than 0.05). There was a good correlation at the DF and at the AChW (DF/AChW) (r: 0.8012; P less than 0.001). From these results, we conclude that the TcPO2 is a good method of differentiating different degrees of leg ischemia in vascular patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle↗
PubMed1983

Are leg ulcers in rheumatoid arthritis due to vasculitis?

Five patients with severe rheumatoid arthritis are reported in whom leg ulcers were not apparently associated with vasculitis. The conventional explanation for these ulcers deserves review. Patients with rheumatoid arthritis may develop 'gravitational' leg ulceration and pressure sores on their legs. In addition, they may develop ulcers on the lower aspects of the legs and around the ankles which are well demarcated, punched out, painful and slow to heal. These ulcers usually occur in patients with longstanding, severe, seropositive disease. They are presently considered to be due to a necrotising arteritis causing dermal infarction, since they are frequently associated with other clinical features of rheumatoid vasculitis. Wilkinson has commented that 'biopsies are seldom taken from leg ulcers'. In this paper we report five patients with severe rheumatoid arthritis who developed such leg ulcers in the absence of other clinical evidence of vasculitis and in whom biopsies of the ulcers failed to reveal vasculitis. A case is summarised as illustrative of the five patients, whose relevant histories, clinical findings, and laboratory investigations are summarised in Table 1.

Aged↗
PubMed1984

[Electromyographic analysis of the leg muscles in the hemiplegic patients with equinovarus deformity of the foot].

A series of EMG study of the leg muscles was carried out with a wire electrode in 86 hemiplegic patients of stroke to visualize the role of each muscle either in the development of equinovarus deformity of the foot or in correcting the deformity through tendon transfer. The muscles examined were anterior tibialis, posterior tibialis, gastrocnemius, soleus, flexor digitorum longus and peroneus brevis of the affected side. Tonic discharge of those muscles was recorded as the patients were elevating the affected leg in supine, sitting or standing posture or were standing on legs. On lifting up the affected limb, most patients showed electrical activity of anterior tibialis with or without simultaneous activity of other muscles, most frequently with that of flexor digitorum longus or gastrocnemius. When the patient stood on legs electromyographic discharge appeared most frequently in soleus. Varus deformity of the foot significantly correlated to the lack of the electrical activity of peroneus brevis. Both such abnormal activity of anterior tibialis and the lack of activity of peroneus seemed to be the main causes for the varus deformity. Postoperative EMG study in the patients who underwent Watkins-Barr procedure of anterior transfer of the posterior tibialis tendon, showed that the posterior tibialis was rather inactive both in elevating the leg and in standing on legs. Varus deformity was corrected independent of the discharge of posterior tibialis. The author concluded that the correction of the varus deformity after Watkins-Barr procedure was mainly obtained from the tenodesis effect. The tenodesis provides the checkline effect on the equinus and varus deformity, which reinforces the dorsiflexing action of anterior tibialis and attenuates its inverting action of the same muscle.

Adult↗
PubMed1984

Short-leg syndrome.

Short-leg syndrome, or asymmetry of length in the lower extremities, is a common orthopedic problem in children. It is vital to recognize normal bone function, bone growth, and potential growth when evaluating this syndrome. Classification of this problem is either structural or functional. Structural (real) short legs usually have trauma or congenital growth inequality as their etiology. Functional (apparent) short legs usually result from soft tissue contractures or foot function aberrations. The child's age determines the extent of our examination. The lower extremity should be segmented during examination to help determine the location of pathology. Measuring the deformity requires precise scientific procedures. The level of compensation must be determined. Foot, pelvic, and spinal compensations should be evaluated. Scanograms or orthoroentgenograms are useful in diagnosing, quantifying, and prognosing short-leg syndrome. Prediction of the projected discrepancy is accomplished by the Anderson et al. remaining growth charts. Common etiologic considerations include congenital, neuromuscular, infection, trauma-induced, and tumor-caused disorders. Treatment of short-leg syndrome is determined by classification. Structural problems may need heel elevation or a combination of heel elevation and orthotic control on a conservative basis. Functional problems may require neutral position control of the feet with orthotics and correction of soft tissue contractures. Resin foam or orthopedic shoe adjustment may be used in moderate discrepancies. Structural leg inequalities may be corrected by surgical epiphysiodesis. This bone growth retardation procedure is normally performed on the long limb in pediatric patients. Therapy is directed at correcting pelvic obliquity, gait and postural aberration. The end result should be a child with cosmetically acceptable and normal functioning lower extremities.

Child↗
PubMed1983

Inter- and intra-examiner reliability of leg-length differential measurement: a preliminary study.

The phenomenon of "short leg" has long been used and debated clinically. A uniquely chiropractic measurement technique was not studied in any of the few studies of reliability of measurement which have been reported. An inter- and intra-examiner reliability study was therefore performed to validate a prone leg length-differential test. Naive students (n = 40) were called, in random order, into three adjacent examining rooms where three experienced chiropractic clinicians measured differential leg lengths. Using standard placement a tape measure was read to the nearest mm to detect inequalities at the shoe-sole interface. The leg length differences were recorded, for both the straight and flexed legs prone positions, twice by each of the three clinicians. Intraclass correlations were significant for the two independent readings for all three examiners, indicating high reliability of the test. Good agreement among examiners was indicated as well by significant intraclass correlation in two of the three possible examiner combinations. These results argue strongly for the reality of the leg length inequality phenomenon and also that it can be reliably measured.

Adult↗