Good posture is more than just standing up straight to look better. It is an important part of your long-term health. Keeping your body in the correct position, whether you are moving or still, can help you avoid pain, injuries, and other health problems.
Etymology and Synonyms: The word "dysmetry" is formed with Greek roots and means "a disorder in performing muscle movements caused by an improper assessment of distance." Its lexical components are: the prefix dis- (bad, difficult), metron (measure), plus the suffix -ia (quality).
Definition: Dysmetry is a condition where the length between the bone segments of the lower limbs is different: it is a common disorder, affecting 1 in 3 people. It refers to the discrepancy in the length of the limbs. Limb dysmetry is a frequent reason for consultation in pediatric orthopedics.
Symptoms and Diagnosis: Discrepancies in the lower limbs lead to altered gait, as well as aesthetic repercussions. In these patients, an irregular and unstable gait occurs, with tilting of the pelvis towards the short limb and deviation of the spine in the opposite direction. On the other hand, it is generally accepted that dysmetries greater than 2.5 cm in adults may lead to lower back pain and scoliosis posture. The most common symptoms include:
• Alteration in gait and constant loss of balance.
• Discomfort while walking and severe pain in the feet, ankles, and knees.
• Scoliosis posture (leaning to one side).
Dysmetry is easy to detect, and the most commonly used diagnostic tests are:
Ultrasonic Methods: It is recommended to perform a general examination with the patient in underwear to assess skin aspects, the length of the upper limbs, among others. In younger ages (especially the first year of life), hip examination is crucial to evaluate dysplastic phenomena.
Osteopathic Tests: These are tests for mobility of different anatomical parts, used to detect structures with reduced mobility and determine the appropriate technique for that specific dysfunction.
Etiology: Causes and Risk Factors: The following causes may result in the actual shortening of the lower limbs:
• Congenital growth deficiencies: About 3-4% of babies born in the United States have congenital malformations affecting their appearance, development, or function, including dysmetry.
• Bone or joint infections: Infections can reach a bone by traveling through the bloodstream or by spreading from nearby tissue. Infections can also start in the bone itself if an injury exposes the bone to germs, which may cause limb length discrepancy.
• Hip prosthetics: Hip prosthetics are designed to mimic the action of the knee joint. During hip replacement surgery, the surgeon removes the damaged parts of the hip joint and inserts the artificial joint, which may cause discrepancies in both limbs.
• Fractures or dysfunctions of the growth cartilage: A fracture of the growth cartilage affects the tissue layers near the ends of a child's bones. Growth cartilages are the softest and weakest sections of the skeleton. Sometimes, they are even weaker than the surrounding ligaments and tendons.
Treatment and Therapies: Once the primary cause of dysmetry is identified, treatment can be easily chosen to combat or reverse its progression. Generally, the type of treatment is selected based on the magnitude of the discrepancy.
• Dysmetries less than 1 cm are usually well tolerated and only require periodic checks during growth stages.
• Differences between 1-3 cm are treated with special insoles or heel lifts that increase height and provide full support to the affected limb, reducing pain.
• Dysmetries greater than 3 cm are usually treated with surgical methods: Patients with dysmetry between 3 and 7 cm can be treated with epiphysiodesis or lengthening techniques, while those with dysmetry greater than 7 cm are generally treated through lengthening, in one or more surgical sessions.
Conclusions: Some dysmetries can be present from birth and may adapt over time, causing no issues. In other cases, when an accident or fracture occurs and a sudden dysmetry develops, it causes pain much quicker, and it is essential to recognize the situation and its level to provide the proper solution.
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