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Effects of Limb-Length Discrepancy on Gait Economy and Lower-Extremity Muscle Activity in Older Adults
Burke Gurney, PhD, PT; Christine Mermier, MS; Robert Robergs, PhD; Anne Gibson, PhD; Dennis Rivero, MD
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Investigation performed at the University of New Mexico, Albuquerque, New Mexico
Burke Gurney, PhD, PT
Division of Physical Therapy, University of New Mexico, HSSB 204B, Albuquerque, NM 87131-5661. E-mail address: bgurney@salud.unm.edu

Christine Mermier, MS
Robert Robergs, PhD
Anne Gibson, PhD
Division of Physical Performance Development, University of New Mexico, Johnson Center, Room B 143, Albuquerque, NM 87131-1251

Dennis Rivero, MD
Department of Orthopaedics, University of New Mexico, Health Sciences Center, Albuquerque, NM 87131-5296

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was an internal University of New Mexico Research Allocation Committee grant.

J Bone Joint Surg Am, 2001 Jun 01;83(6):907-915
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Background: The amount of limb-length discrepancy necessary to adversely affect gait parameters in older adults is unknown, with information being largely anecdotal. This investigation was conducted to determine the effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults.

Methods: Forty-four men and women ranging in age from fifty-five to eighty-six years with no evidence of limb-length discrepancy of >1 cm participated in the study. Subjects walked on a treadmill at a self-selected normal walking pace with artificial limb-length discrepancies of 0, 2, 3, and 4 cm applied in a randomly selected order. Indirect calorimetry was used to measure oxygen consumption and minute ventilation. Electromyography was used to measure muscle activity of the right and left quadriceps femoris, plantar flexors, gluteus maximus, and gluteus medius. Heart rate, the rating of perceived exertion, and frequency of gait compensation patterns were also measured.

Results: There was a significant increase in oxygen consumption and the rating of perceived exertion with 2, 3, and 4-cm artificial limb-length discrepancies; a significant increase in heart rate, minute ventilation, and quadriceps activity in the longer limb with 3 and 4-cm artificial limb-length discrepancies; and a significant increase in plantar flexor activity in the shorter limb with a 4-cm artificial limb-length discrepancy compared with the same parameters with no artificial limb-length discrepancy.

Conclusions: Both oxygen consumption and the rating of perceived exertion were greater with a 2-cm artificial limb-length discrepancy than they were with no artificial limb-length discrepancy. There appears to be a breakpoint between 2 and 3 cm of artificial limb-length discrepancy in older adults with regard to the effects on most other physiological parameters. A 3-cm artificial limb-length discrepancy is likely to induce significant quadriceps fatigue in the longer limb. Elderly patients with substantial pulmonary, cardiac, or neuromuscular disease may have difficulty walking with a limb-length discrepancy as small as 2 cm.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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