The Orthotic Management of the Congenitally Short Lower Limb - A New Appliance

AS Devnani
Correspondence: Dr A S Devnani, devnani@kb.usm.my

ABSTRACT
Aim To describe an appliance used for equalisation of severe congenital lower limb length discrepancy for patients who refuse to undergo any operative correction but wish to walk and look better.
Method The appliance which is a combination of an ischial bearing brace and a below knee prosthesis was fitted to four patients, aged between 12 and 31 years, with congenital shortening of the lower limb ranging between 17 to 27 centimetres. The diagnosis was proximal femoral focal deficiency in 2 patients, hypoplastic femur in 1 and tibial hemimelia in the fourth patient. The appliance could accommodate existing deformities of the knee, ankle and foot without any operative correction as well as equalise the lower limb length. It is modular in construction and could be easily assembled from off-the-shelf components.
Result The appliance improves the gait as well as the appearance, could be fitted to the patient without the prior need of operative correction and could be well disguised under any loose fitting garment. Four patients with severe congenital shortening of the leg have used it for over three years and are pleased with it. It requires little maintenance.
Conclusion The appliance is useful for patients with severe congenital shortening of the lower limb who refuse to undergo operative correction.

Keywords: severe congenital shortening, refuse operation, new appliance
Singapore Med J 2000; 41(11): 534-537