Management of Lower Limb Dysmetria

Assessment and Diagnosis

Accurate assessment of lower limb dysmetria should include measurement of intercondylar and/or intermalleolar distance to evaluate the severity of varus or varus leg deformities 1
Regular clinical evaluation should include assessment of limb symptoms, functional status, lower extremity pulse examination, and foot assessment 2
The 6-minute walk test (6MWT) in patients can help quantify the functional consequences of dysmetria on bone and muscles 1
Radiographic assessment is often necessary as clinical measurements alone cannot fully assess lower limb deformity and joint alignment 1

Encourage optimal postural alignment at rest and during functional activities, considering a 24-hour management approach 3, 4
Promote even distribution of weight in sitting, transfers, standing and walking to normalize movement patterns and muscle activity 3, 4
Grade activities to increase the time that the affected limb is used with normal movement techniques within functional activities 3, 4
Implement tasks that promote normal movement, good alignment and even weight-bearing, such as transfers, sit-to-stand exercises, and standing activities 3, 4
Employ anxiety management and distraction techniques when undertaking tasks to improve motor control 3, 4

Ambulatory assistive devices should be used to help with gait and balance impairments, as well as mobility efficiency and safety when needed 5
Ankle-foot orthoses (AFOs) should be used for ankle instability or dorsiflexor weakness to improve walking disability, step/stride length, and balance 5
Wheelchairs should be prescribed for non-ambulatory individuals or those with limited walking ability to increase participation and improve quality of life 5
The prescription of assistive devices should be specific to the patient's needs, environment, and preferences 5

Surgical treatment should be performed only after medical treatment has been maximized for at least 12 months 6
Surgery should be performed by a surgeon with expertise in metabolic bone diseases 6
Consider surgical intervention when there is persisting deformity despite optimized medical treatment and/or the presence of symptoms interfering with function 6
The age of the patient is an important factor in the decision-making process: guided growth techniques depend on remaining growth potential and must be carried out at least 2-3 years before skeletal maturity 6
Following surgery, regular clinical and functional assessments should be made, including radiography at 12 months post-surgery, or earlier if bone deformity worsens 6

Splinting may prevent restoration of normal movement and function and should be used cautiously 3, 4
Potential problems with splinting include increasing attention to the area, increasing accessory muscle use, compensatory movement strategies, immobilization leading to muscle deconditioning, learned non-use, and increased pain 3, 4
Avoid postures that promote prolonged positioning of joints at the end of range 3, 4
Address associated problems of pain and hypersensitivity which may accompany lower limb dysmetria 3, 4
Recognize that lower limb dysmetria is associated with impaired lower extremity functioning and reduced quality of life 7

Patients should receive regular follow-up with multidisciplinary teams organized by an expert in metabolic bone diseases 1
Coordination of care among clinicians is essential to improve management and optimize patient outcomes 2
Periodic assessment of functional status and overall health-related quality of life should be included as components of longitudinal follow-up 2
For patients who have undergone lower extremity revascularization, follow-up should include periodic clinical evaluation of lower extremity symptoms and pulse and foot assessment 2