Lameness develops with injuries, degenerative and inflammatory diseases of bones, joints, soft tissues, vascular diseases, neurological, dermatological pathologies. It may occur due to pain, limb deformity, paresis, blood supply disorders. Lameness can be permanent, periodic 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, taking analgesics is acceptable.
Causes of lameness
Traumatic injuries
Lameness is observed in mild and moderate closed and open injuries of the lower extremities with preservation of the integrity of bone structures:
- bruises of the foot, shin, hip, ankle, knee, hip joints;
- soft tissue hematomas;
- ligament damage;
- meniscus injuries;
- hemarthrosis;
- cut, torn, bruised, stabbed, other wounds.
Distinctive features are a sudden onset, a clear connection with the injury. The severity of lameness depends on the severity and localization of the injury. There is swelling, bruising is possible. Most fractures of the lower extremities entail a complete loss of the ability to lean on the leg. Lameness develops less often, it is observed with injuries such as:
- Fractures of small bones of the foot (tarsus, phalanges of fingers).
- Fracture of the fibula.
- Impaled fracture of the femoral neck.
The injuries that cause this symptom include a marching or fatigue fracture. Lameness is also noted during the recovery period after severe and moderate limb injuries. It may be associated with insufficient formation of bone corns in fractures, muscle atrophy, impaired joint mobility due to prolonged immobilization and lack of exercise.
Inflammatory and degenerative diseases
Lameness manifests many degenerative and inflammatory diseases of various anatomical structures of the lower extremities. Soft tissue pathologies accompanied by this symptom include:
- Enthesopathies: trochanteritis, anserine bursitis, enthesopathy of the patella’s own ligament, plantar fasciitis.
- Tendinitis and tendovaginitis: tendovaginitis of the foot, tendinitis of the Achilles tendon, tendons of the hip, 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 bones and joints:
- Arthrosis: coxarthrosis, gonarthrosis, arthrosis of the ankle and foot joints.
- Aseptic arthritis: reactive, rheumatoid, psoriatic, gouty.
- Infectious arthritis: nonspecific purulent, specific gonorrhea, dysentery, syphilitic, with osteoarticular tuberculosis.
- Secondary arthritis: in blood diseases, malignant neoplasia, sarcoidosis, pathologies of the respiratory and digestive systems.
- Inflammatory bone diseases: periostitis, chronic osteomyelitis.
- Osteochondropathies: Perthes’ disease, Keller’s disease I and II, Shinz’s disease.
- Other bone pathologies: juvenile epiphyseolysis of the femoral head.
Many pathologies of 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.
Deformities of the limbs
In addition to the reasons listed above, the curvature and shortening of the legs that cause lameness are diagnosed with the following conditions:
- Post-traumatic deformities: after fractures of the diaphysis of the thigh and lower leg, near- or intra-articular fractures, extensive burns, wounds with a soft tissue defect.
- 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, Ollier’s disease, deforming osteitis.
- Cysts, tumors: bone cyst, osteoma, osteosarcoma, Ewing’s sarcoma, other benign and malignant neoplasia (due to limb damage during neoplasm growth or after bone resection).
Neurological and vascular diseases
Lameness is determined in the following vascular pathologies:
- Lesions of peripheral arteries: obliterating endarteritis, obliterating atherosclerosis of the lower extremities, peripheral atherothrombosis, Menkeberg arteriosclerosis.
- Diseases of the heart and large arteries: Lerish syndrome, aortic aneurysm, aortic coarctation, weak sinus node syndrome.
- Venous diseases: 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 lameness is detected, with pathologies of veins and lymphatic vessels – the usual one. In addition, intermittent claudication is characteristic of neurological diseases caused by disorders of spinal circulation: myelogenous and caudogenic intermittent claudication, the initial stage of ischemic spinal stroke.
In neurological disorders of non-vascular genesis, lameness is permanent or periodic, associated with paresis, paralysis or nerve infringement. It is detected in the following cases:
- Non-traumatic radicular syndrome: osteochondrosis, intervertebral hernia, spondylosis, spondyloarthrosis, tuberculosis, osteomyelitis of the spine, spinal cord tumors.
- Traumatic radicular syndrome: fractures, subluxations of the vertebrae, spondylolisthesis.
- Neuritis and neuropathies: neuropathy of the sciatic, femoral, tibial, fibular nerves.
- Myelitis: infectious, with multiple sclerosis, vasculitis, some autoimmune diseases.
Lameness is also observed in the outcome after incomplete traumatic spinal cord injuries, with cerebral palsy, and other diseases.
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: watery, dry and taper calluses, corn abscess, ingrown toenail, complicated foot mycoses.
- Infectious: mycetoma of the foot, tungiosis.
- Mental: hysteria.
Diagnostics
Determination of the causes of lameness is carried out by traumatologists-orthopedists. In vascular diseases, patients are examined by a vascular surgeon, in neurological pathologies – by a neurologist. The examination plan includes the following diagnostic procedures:
- Survey. The doctor specifies under what circumstances the lameness appeared, what kind of character it has (constant, periodic, intermittent), what symptoms it is accompanied by.
- External inspection. The specialist evaluates the patient’s gait, measures the length of the legs, identifies deformities, examines joint mobility, determines the condition of the skin and soft tissues.
- Radiography. The images show fractures, arthrotic changes, inflammatory processes, cysts and tumors in bones and joints.
- Ultrasound. It is recommended for vascular pathologies and soft tissue diseases. Allows you to assess the patency of blood vessels, the cause and degree of blood flow disorders, the severity of pathological changes.
- CT and MRI. They are prescribed to clarify the results of radiography, sonography of the limbs. They are used to determine the severity of the lesion in cases of cerebrospinal circulation disorders.
- Electrophysiological techniques. Electromyography, electroneurography, evoked potentials are used to assess the level of neuromuscular transmission, localization of 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, tissue samples are taken, if necessary, therapeutic measures are carried out.
- Laboratory tests. They are necessary to confirm inflammatory changes in the blood, identify specific markers in autoimmune diseases, identify pathogens in infectious pathologies, and study the morphological structure of biopsies.
Treatment
First aid
In case of traumatic injuries, they provide rest, temporarily fix the limb with a splint or a soft bandage, give painkillers, apply cold. In other conditions, they limit the load on the leg, pick up comfortable shoes, if necessary, use a cane, crutches.
Conservative therapy
With lameness , the following therapeutic measures can be carried out:
- Protective mode. A plaster cast can be applied to the patient, it is recommended to observe rest, refrain from walking long distances, use additional devices for unloading the limb (crutches, cane, walker).
- Orthopedic constructions. The goal is to support the affected segment, reduce or redistribute the load, equalize the length of the legs. Splints, insoles, orthopedic shoes are used.
- Drug therapy. Prescribe analgesics, antibiotics, NSAIDs, vitamin complexes, means to improve blood circulation, drugs to restore nerve conduction.
- Physical therapy. UHF, ultrasound, laser therapy, magnetic therapy, drug electrophoresis, shock wave therapy, and other techniques can be recommended to reduce inflammation and pain, stimulate recovery processes.
- Physical therapy. It is an important part of the treatment of many diseases accompanied by lameness. It may include exercises to increase muscle strength and joint mobility, improve coordination of movements, and correct motor stereotypes.
- Other methods. Massage and manual therapy are widely used. In recent years, taping has been increasingly carried out.
Surgical treatment
Taking into account the peculiarities of pathology in lameness , the following operations are performed:
- Traumatic injuries: suturing of wounds, opening of hematomas, open removal of menisci, arthroscopic meniscectomy, osteosynthesis of the impaled fracture of the femoral neck.
- Infectious processes: autopsy, drainage of abscesses, arthrotomy for purulent arthritis.
- Congenital and acquired deformities: elimination of curvature, elongation of the lower leg or thigh by Ilizarov apparatus, various types of bone grafting.
- Oncological diseases: tumor removal, bone resection, amputation and exarticulation.
- Venous diseases: phlebectomy, miniflebectomy, RFA and laser coagulation of varicose veins, thrombectomy, crossectomy, installation of a cava filter, venous bypass surgery, etc.
- Arterial pathologies: sympathectomy, thromboembolectomy, endarterectomy, stenting, shunting and other reconstructive interventions.
- Neurological diseases: removal of spinal cord tumors, elimination of spinal canal stenosis, stabilizing interventions on the spine.
Arthroplasty, arthrodesis, and endoprosthetics are used to improve joint function and increase limb support in joint lesions of various genesis.
