Lameness develops with injuries, degenerative and inflammatory diseases of bones, joints, soft tissues, vascular diseases, neurological, dermatological pathologies. It can occur due to pain, limb deformity, paresis, circulatory disorders. Lameness can be constant, intermittent, or intermittent. The diagnosis is made on the basis of anamnesis, examination data, radiography, CT, and other studies. Before determining the cause of lameness, it is possible to use additional devices (canes, crutches), in some cases, it is acceptable to take analgesics.
Why lameness occurs
Lameness is observed in light and moderate closed and open injuries of the lower extremities with preservation of the integrity of the bone structures:
- bruises of the foot, lower leg, thigh, ankle, knee, hip joints;
- soft tissue hematomas;
- ligament damage;
- meniscus injury;
- cut, torn, bruised, stab, other wounds.
Distinctive features are a sudden onset, a clear connection with trauma. The severity of lameness depends on the severity and location of the injury. Swelling is observed, bruising is possible. Most fractures of the lower extremities entail a complete loss of the ability to lean on the leg. Lameness develops less frequently, observed with injuries such as:
- Fractures of small bones of the foot (tarsus, phalanges).
- Fracture of the fibula.
- Impacted fracture of the femoral neck.
Injuries that cause this symptom include a marching or fatigue fracture. Lameness is also noted during the recovery period after severe and moderate injuries of the extremities. It may be associated with insufficient formation of callus in fractures, muscle atrophy, impaired joint mobility due to prolonged immobilization and lack of load.
Inflammatory and degenerative diseases
Lameness manifests itself in many degenerative and inflammatory diseases of various anatomical structures of the lower extremities. Pathologies of soft tissues accompanied by this symptom include:
- Enthesopathies: trochanteritis, anserine bursitis, enthesopathy of the patellar ligament, plantar fasciitis.
- Tendonitis and tendovaginitis: tendovaginitis of the foot, tendonitis of the Achilles tendon, tendons of the thigh, knee joint.
- ARS syndrome.
- Myositis of the muscles of the lower extremities.
- Purulent processes: boils, abscesses.
Lameness caused by pain syndrome, secondary deformity, can be detected in the following diseases of the bones and joints:
- Arthrosis : coxarthrosis, gonarthrosis, arthrosis of the ankle and foot joints.
- Aseptic arthritis : reactive, rheumatoid, psoriatic, gouty.
- Infectious arthritis: nonspecific purulent, specific gonorrheal, dysentery, syphilitic, with osteoarticular tuberculosis.
- Secondary arthritis : with blood diseases, malignant neoplasia, sarcoidosis, pathologies of the respiratory and digestive systems.
- Inflammatory bone diseases : periostitis, chronic osteomyelitis.
- Osteochondropathy : Perthes' disease, Keller's disease I and II, Schinz's disease.
- Other bone pathologies : juvenile epiphysiolysis of the femoral head.
Many pathologies of the joints and periarticular tissues during the period of exacerbation are accompanied by the development of synovitis, which either cause lameness or aggravate an existing symptom.
In addition to the causes listed above, curvature and shortening of the legs, causing lameness, are diagnosed under the following conditions:
- Post- traumatic deformities : after fractures of the diaphysis of the femur and lower leg, near- or intra-articular fractures, extensive burns, wounds with soft tissue defects.
- Congenital anomalies : dysplasia and congenital dislocation of the hip joint, underdevelopment of the femur or tibia, valgus and varus deformities of the lower extremities, congenital dislocation and false joint of the tibia.
- Diseases of the musculoskeletal system : Blount's disease, some forms of hyperostosis, Olier's disease, osteitis deformans.
- Cysts, tumors : bone cyst, osteoma, osteosarcoma, Ewing's sarcoma, other benign and malignant neoplasias (due to limb damage during neoplasm growth or after bone resection).
Neurological and vascular diseases
Lameness is determined in the following vascular pathologies:
- Peripheral arterial lesions : obliterating endarteritis, obliterating atherosclerosis of the lower extremities, peripheral atherothrombosis, Menckeberg's arteriosclerosis.
- Diseases of the heart and large arteries : Leriche's syndrome, aortic aneurysm, aortic coarctation, weak sinus node syndrome.
- Diseases of the veins : chronic venous insufficiency, thrombophlebitis, post-thrombophlebitic syndrome, venous trophic ulcers.
- Lesions of the lymphatic system : lymphangitis, purulent lymphadenitis, lymphostasis, lymphedema.
With the involvement of the arteries, intermittent claudication is found, with pathologies of the veins and lymphatic vessels - the usual one. In addition, intermittent claudication is characteristic of neurological diseases caused by disorders of the spinal circulation: myelogenous and caudogenic intermittent claudication, the initial stage of ischemic spinal stroke.
In neurological disorders of non-vascular origin, lameness is permanent or intermittent, associated with paresis, paralysis, or nerve entrapment. Detected in the following cases:
- Non-traumatic radicular syndrome : osteochondrosis, intervertebral hernia, spondylosis, spondylarthrosis, tuberculosis, osteomyelitis of the spine, tumors of the spinal cord.
- Traumatic radicular syndrome : fractures, subluxations of the vertebrae, spondylolisthesis.
- Neuritis and neuropathy : neuropathy of the sciatic, femoral, tibial, peroneal nerves.
- Myelitis: infectious, with multiple sclerosis, vasculitis, some autoimmune diseases.
Lameness is also observed in the outcome after incomplete traumatic injuries of the spinal cord, with cerebral palsy, and other diseases.
Lameness can be provoked by lesions of the skin of the feet, develop under the influence of an altered mental state. Possible pathologies:
- Dermatological : water, dry and core corns, corn abscess, ingrown nail, complicated foot mycoses.
- Infectious : mycetoma of the foot, tungiosis.
- Mental : hysteria.
Establishing the causes of lameness is carried out by orthopedic traumatologists. In case of vascular diseases, patients are examined by a vascular surgeon, in case of neurological pathologies - by a neurologist. The examination plan includes the following diagnostic procedures:
- Poll . The doctor specifies under what circumstances lameness appeared, what character it has (constant, intermittent, intermittent), what symptoms it accompanies.
- External inspection . The specialist evaluates the patient's gait, measures the length of the legs, detects deformities, examines the mobility of the joints, determines the condition of the skin and soft tissues.
- Radiography . The pictures show fractures, arthrotic changes, inflammation, cysts and tumors in the bones and joints.
- ultrasound . Recommended for vascular pathologies and soft tissue diseases. Allows you to assess the patency of blood vessels, the cause and degree of impaired blood flow, the severity of pathological changes.
- CT and MRI . Appointed to clarify the results of radiography, sonography of the extremities. They are used to determine the severity of the lesion in violations of the spinal circulation.
- Electrophysiological Methods . Electromyography, electroneurography, evoked potentials are used to assess the level of neuromuscular transmission, localize the level of nerve damage.
- Invasive Research . If the joints are affected, a puncture or arthroscopy can be performed. In the first case, the nature of the synovial fluid is assessed, in the second, the joint is examined, if necessary, tissue samples are taken, and therapeutic measures are taken.
- Laboratory tests . They are necessary to confirm inflammatory changes in the blood, to identify specific markers in autoimmune diseases, to identify pathogens in infectious pathologies, to study the morphological structure of biopsy specimens.
Putting on a plaster cast
In case of traumatic injuries, they provide rest, temporarily fix the limb with a splint or soft bandage, give painkillers, and apply cold. In other conditions, the load on the leg is limited, comfortable shoes are selected, and if necessary, a cane and crutches are used.
With lameness, the following therapeutic measures can be carried out:
- Protective mode . The patient may be put in a plaster cast, advised to remain calm, refrain from walking long distances, use additional devices to unload the limb (crutches, cane, walker).
- Orthopedic designs . The goal is to support the affected segment, reduce or redistribute the load, equalize the length of the legs. Use splints, insoles, orthopedic shoes.
- Medical therapy . Prescribe analgesics, antibiotics, NSAIDs, vitamin complexes, drugs to improve blood circulation, drugs to restore nerve conduction.
- Physiotherapy . To reduce inflammation and pain, stimulate recovery processes, the patient may be recommended UHF, ultrasound, laser therapy, magnetotherapy, drug electrophoresis, shock wave therapy, and other techniques.
- exercise therapy . It is an important part of the treatment of many diseases accompanied by lameness. May include exercises to increase muscle strength and joint mobility, improve coordination of movements, correct motor stereotypes.
- Other methods . Massage and manual therapy are widely used. Taping has become more and more popular in recent years.
Taking into account the characteristics of the pathology with lameness, the following operations are performed:
- Traumatic injuries : suturing wounds, opening hematomas, open removal of menisci, arthroscopic meniscectomy, osteosynthesis of an impacted fracture of the femoral neck.
- Infectious processes : opening, drainage of abscesses, arthrotomy in purulent arthritis.
- Congenital and acquired deformities : elimination of curvature, lengthening of the lower leg or thigh with the Ilizarov apparatus, various types of bone grafting.
- Oncological diseases : tumor removal, bone resection, amputations and disarticulations.
- Diseases of the veins : phlebectomy, miniphlebectomy, RFA and laser coagulation of varicose veins, thrombectomy, crossectomy, cava filter installation, venous bypass surgery, etc.
- Arterial pathologies : sympathectomy, thromboembolectomy, endarterectomy, stenting, shunting and other reconstructive interventions.
- Neurological diseases : removal of tumors of the spinal cord, elimination of spinal canal stenosis, stabilizing interventions on the spine.
Arthroplasty, arthrodesis, arthroplasty are used to improve the function of the joints and increase the support of the limb in case of articular lesions of various origins.