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182 ATYPICAL CAUSES OF LEG ULCERATION
https://t.me/medicina_free
van den Hoogen, F., Khanna, D., Fransen, J. etal. (2013). 2013 classication
criteria for systemic sclerosis: an American College of Rheumatology/
European League Against Rheumatism collaborative initiative. Annals
of the Rheumatic Diseases 65 (11): 2737–2747.
Hudson, M., Thombs, B., Steele, R. etal. (2009). Health-
in systemic sclerosis: a systematic review. Arthritis and Rheumatism
61 (8): 111201120.
Hunt, S. (2017). Top tips: skin and tissue trauma caused by self-
International 8 (4): 12–17.
International Wound Infection Institute (IWII) (2022) Wound Infection in
Clinical Practice. https://woundinfectionuploads/IWII-
Isoherranen, K., Jordan O’Brien, J., Barker, J. etal. (2019). Atypical wounds:
best clinical practice and challenges. EWMA document. Journal of
Wound Care 28 (6): S1–S92.
Jebakumar, A., Udayakumar, D., Crowson, C. etal. (2014). Occurrence and
impact of lower extremity ulcer in rheumatoid arthritis– a
based study. Journal of Rheumatology 41 (3): 437–443.
CD- 2022- web- 1.pdf
related quality of life
harm. Wounds
institute.com/wp- content/
population
of the management of diabetic foot ulcers using ulcerperson-
related measures. Diabetes Care 29: 1784–1787.
Jones, O.T., Ranmuthu, C.K.I., Hall, P.N. etal. (2020). Recognising skin can-
cer in primary care. Advances in Therapy 37: 603–616.
Karimkhani, C., Boyers, L.N., Dellavalle, R.P., and Weinstock, M.A. (2015).
It’s time for ‘keratinocyte carcinoma’ to replace the term ‘ nonmelanoma
skin cancer’. Journal of the American Academy of
186–187.
Kavitha, K.V., Tiwari, S., Purandare, V.B. etal. (2014). Choice of wound care
in diabetic foot ulcer: a practical approach. World Journal of Diabetes
5 (4): 554–556.
Khimdas, S., Harding, S., Bonner, A. etal. (2011). Associations with digital ulcers
in a large cohort of systemic sclerosis: results from the Canadian scleroderma research group registry. Arthritis Care and Research 63: 142–149.
Kilroy- Findley, A. and Bateman, S. (2016). Case studies: Octenilin wound
irrigation solution and Octenisan wash in self- harm wounds. Wounds
UK 12 (4): 88–94.
Kim, H.S., Lee, J.S.S., and Tand, M.B.Y. (2010). Localized ecthyma
gangrenosum in patients with diabetes mellitus: diagnosis and management. Journal of Dermatology 37: 758–761.
King, T., Carr, R.A., and Sharma, M. (2017). A painful leg ulcer. Clinical and
Experimental Dermatology 42: 106–108.
Kodumudi, V., Jeha, G.M., Mydlo, N., and Kaye, A.D. (2020). Management of
cutaneous calciphylaxis. Advances in Therapy 37 (12): 4797–4807.
Dermatology 72 (1):
related and
本书版权归John Wiley & Sons Inc.所有
Atypical Causes of Leg Ulceration 183
https://t.me/medicina_free
Koshy, M., Entuah, R., Koranda, A. etal. (1989). Leg ulcers in patients with
sickle cell disease. Blood 74 (4): 1403–1408.
Kuypers, D.R.J. (2009). Skin problems in chronic kidney disease. Nature
Clinical Practice. Nephrology 5 (3): 157–170.
Lacroix, R., Kalisiak, M., and Rao, J. (2008). Can you identify this
Canadian Family Physician 54 (6): 857–867.
Lang, K., Neil, J., Wright, J. etal. (2013). Qualitative investigation of barriers
toaccessing care by people who inject drugs in Saskatoon,
spectives of service providers. Substance Abuse Treatment, Prevention,
and Policy 8: 35.
Lee, K., Carley, S., Kraus, C., and Mesinkovska, N.A. (2020). Treatment of
erosive pustular dermatosis: a systematic review of the literature. Inter-
national Journal of Dermatology 59 (7): 770–786.
Leloup, P., Toussaint, P., Lembelembe, J.P. etal. (2015). The analgesic eect
of electrostimulation (WoundEL) in the treatment of leg ulcers. Interna-
tional Wound Journal 12: 706–709.
Mackie, R.M. (1990). Clinical recognition of early invasive malignant mela-
noma. BMJ 301 (6759): 1005–1006.
Mansour, M. and Alavi, A. (2019). Martorell ulcer: chronic wound
management and rehabilitation. Chronic Wound Care Management
Research 6: 83–88.
Maronese, C., Pimentel, M., Li, M. et al. (2022). Pyoderma gangrenosum:
anupdated literature review on established and emerging pharmacological treatment. American Journal of Clinical Dermatology 23:
615–634.
Maverakis, E., Ma, C., Shinkai, K. etal. (2018). Diagnostic criteria of ulcera-
tive pyoderma gangrenosum. A Delphi consensus of international
experts. JAMA Dermatology 154: 461–466.
Menendez, M. and Warriner, R.A. (2006). Marjolin’s ulcer: report of 2 cases.
Wounds 18 (3): 65–70.
Micheletti, R.G. (2022). Treatment of cutaneous vasculitis. Frontiers in Medi-
cine (Lausanne) 9: 1059612.
Minniti, C.P. and Kato, G. (2016). How we treat sickle patients with leg
ulcers. American Journal of Hematology 91 (1): 22–30.
Misciali, C., Dika, E., Fanti, P.A. et al. (2013). Frequency of malignant
neoplasms in 257 chronic leg ulcers. Dermatologic Surgery 39 (6):
849–854.
Mistry, B.D., Alavi, A., Ali, S., and Mistry, N. (2017). A systematic review of
the relationship between glycaemic control and necrobiosis lipoidica
diabeticorum in patients with diabetes mellitus. International Journal of
Dermatology 56: 1319–1327.
Murray, C.A. and Miller, R.A. (1997). Necrobiosis lipoidica diabeticorum and
thyroid disease. International Journal of Dermatology 36: 799.
condition?
Canada: per-
本书版权归John Wiley & Sons Inc.所有
184 ATYPICAL CAUSES OF LEG ULCERATION
https://t.me/medicina_free
National Institute for Health and Care Excellence (NICE) (2016). Sunlight
exposure: risks and benets. NICE guideline [NG34]. https://www.
nice.org.uk/guidance/ng34
National Institute for Health and Care Excellence (NICE) (2020). Clinical
knowledge summary: Rheumatoid arthritis – how common is it?
https://cks.nice.org.uk/topics/rheumatoid information/prevalence- incidence
National Institute for Health and Care Excellence (NICE) (2022a).
clinical knowledge summary. https://cks.nice.org.uk/
National Institute for Health and Care Excellence (NICE) (2022b). Self
harm – assessment, management and preventing reccurrence. NICE
guideline [NG225]. www.nice.org.uk/guidance/ng225
National Wound Care Strategy Programme (2023). Recommendations for
lower limb ulcer. https://www.nationalwoundcarestrategy.net/wpcontent/uploads/2023/08/NWCSP-
1.8.2023.pdf
Nelzen, O., Bergqvist, D., and Lindhagen, A. (1994). Venous and non- venous
leg ulcers: clinical history and appearance in a population study. British
Neuber, H. (2008). Leishmaniasis. Journal der Deutschen Dermatologischen
Gesellschaft 6: 754–765.
Ng, A.T. and Peng, D.H. (2011). Calciphylaxis. Dermatologic Therapy
24: 256–262.
Ngan, V. (2005). Calcinosis cutis. DermNetNZ. https://dermnetnz.org/
topics/calcinosis-
NHS Choices (2015) Self-
feelings- symptoms- behaviours/behaviours/self- harm
Nichol, P., Perceau, G., Barbe, C., and Bernard, P. (2017). Erosive pustular
dermatosis of the leg: a prospective, multicentre, observational study of
36 cases. Annales de Dermatologie et de Venereologie 144(10): 582–588.
Nickles, M., Tsoukas, M., Sweiss, N. etal. (2022). Atypical ulcers: a stepwise
approach for clinicians. Wounds 34 (10): 236–244.
Nigwekar, S.U., Thadhani, R., and Brandenburg, V.M. (2018). Calciphylaxis.
New England Journal of Medicine 378 (18): 1704–1714.
Oakley, A. (2016). Dierential diagnosis of leg ulcer. https://dermnetnz.
org/topics/dierential- diagnosis- of- leg- ulcer
Oakley, A. (2021). Necrobiosis lipoidica. DermNetNZ. https:// dermnetnz.
org/topics/necrobiosis- lipoidica
Oakley, A. and Stevens, T. (2023). Dermoscopy. DermNetNZ. https://
dermnetnz.org/topics/dermoscopy
Ousey, K., Chadwick, P., and Cook, L. (2011). Diabetic foot or pressure ulcer
on the foot? Wounds UK 7 (3): 105–108.
Paron, N.G. and Lambert, P.W. (2000). Cutaneous manifestations of diabetes
mellitus. Primary Care 27: 371–383.
cutis
harm. https://www.nhs.uk/mental- health/
Leg- Ulcer- Recommendations-
arthritis/ background-
Melanoma
topics/melanoma.
本书版权归John Wiley & Sons Inc.所有
Atypical Causes of Leg Ulceration 185
https://t.me/medicina_free
Partsch, H. and Mortimer, P. (2015). Compression for leg wounds. British
Journal of Dermatology 173: 359–369.
Patel, G. and Piguet, V. (2022). Uncommon causes of ulceration. In: ABC of
Wound Healing, 2e (ed. A. Price, J. Grey, G. Patel, and K.
Oxford: Wiley-
Paul, J.C. and Pieper, B.A. (2008). Topical metronidazole for the
wound odour: a review of the literature. Ostomy/Wound Management
54 (3): 18–27.
Poccia, I., Persichetti, P., Marangi, G.F. etal. (2014). Basal cell
arising in a chronic venous leg ulcer: two cases and a review of the
literature. Wounds 26 (4): E30–E35.
Pope, J.E. (2022). Limited cutaneous systemic sclerosis. BMJ Best
https://bestpractice.bmj.com/topics/encutaneous%20systemic%20sclerosis.pdf
Price, A., Grey, J., Patel, G., and Harding, K. (ed.) (2022). ABC of Wound Heal-
ing, 2e. Oxford: Wiley-
Ramadan, F. (2023). Adverse cutaneous drug reactions: manifestations, diagno-
sis and management. British Journal of Community Nursing 28(2): 72–76.
Rayner, R., Carville, K., Keaton, J. et al. (2009). Leg ulcers: atypical
presentations and associated comorbidities. Wound Practice and
Research 17 (4): 168–185.
Reid, S.D., Ladizinski, B., Lee, K. etal. (2013). Update on necrobiosis lipoid-
ica: a review of etiology, diagnosis, and treatment options.
American Academy of Dermatology 69: 783–791.
Reschke, R., Grunewald, S., Paasch, U. etal. (2021). Erosive pustular derma-
tosis of the scalp: clinicopathological correlation leading to a denition.
Wounds 33 (6): 143–146.
Rice, J. (2007). Unusual leg ulcers: a global phenomenon. Primary Intention
15 (4): 165–175.
Roncada, E.V., Abreu, M.A., Pereira, M.F. etal. (2012). Calciphylaxis, a diag-
nostic and therapeutic challenge: report of a successful case. Anais Bra-
sileiros de Dermatologia 87 (5): 752–755.
Saaiq, M. and Ashraf, B. (2014). Marjolin’s ulcers in the post- burned
lesions and scars. World Journal of Clinical Cases 2 (10): 507–514.
Sanchez, D.P., Tookes, H., Pastar, I., and Lev- Tov, H. (2021). Wounds and skin
and soft tissue infections in people who inject drugs and the utility of
syringe service programs in their management. Advances in Wound
Care 10 (10): 571–582.
Santos- Juanes, J., Galache, C., Curto, J.R. etal. (2004). Squamous cell carci-
noma arising in long- standing necrobiosis lipoidica. Journal of the Euro-
pean Academy of Dermatology and Venereology 18 (2): 199–200.
Scott- Thomas, J., Hayes, C., Ling, J. etal. (2017). A practice guide to system-
atic wound assessment to meet the 2017–19 CQUIN target. Journal of
Community Nursing 31 (5): 30–34.
Blackwell.
gb/593/pdf/593/ Limited%20
Blackwell.
Harding), 49.
treatment of
carcinoma
Practice.
Journal of the
本书版权归John Wiley & Sons Inc.所有
186 ATYPICAL CAUSES OF LEG ULCERATION
https://t.me/medicina_free
Seitz, C.A., Berens, N., Brocker, E.- B. etal. (2010). Leg ulceration in rheuma-
toid arthritiserable morbidity: analysis of thirtyliterature. Dermatology 220 (3): 268–273.
Senet, P. (2014). Cutaneous cancers and chronic leg ulcers.
21 (2): 75–80.
Senet, P., Combemale, P., Combemale, P. et al. (2012). Malignancy and
chronic leg ulcers: the value of systematic wound biopsies: a prospective, multicenter, cross- sectional study. Archives of Dermatology 148 (6):
704–708.
Shanmugam, V.K., Price, P., Attinger, C.E. et al. (2010). Lower extremity
ulcers in systemic sclerosis: features and response to therapy.
International Journal of Rheumatology 2010: 747946.
Shelling, M.L., Federman, D.G., and Kirsner, R.S. (2010). Clinical approach
to atypical wounds with a new model for understanding hypertensive
ulcers. Archives of Dermatology 146 (9): 1026–1029.
Shimizu, I., Cruz, A., Chang, K.H., and Dufresne, R.G. (2011). Treatment of
squamous cell carcinoma in situ: a review. Dermatologic Surgery 37 (10):
Stringer, J., Donald, G., Knowles, R., and Warn, P. (2014). The symptom man-
agement of fungating malignant wounds using a novel essential oil
cream. Wounds UK 10 (3): 54–59.
Tandler, S. and Stephen- Haynes, J. (2017). Fungating wounds: management
and treatment options. British Journal of Nursing 26(12): S6–S14.
Tate, S., Price, A., and Harding, K. (2019). Cutaneous wounds in systemic
sclerosis. Wounds UK 15 (1): 44–47.
Tchanque-
basal cell carcinomas masquerading as venous leg ulcers. Advances in
Skin & Wound Care 31 (3): 130–134.
Tillman, D. (2004). Uncommon causes of leg ulceration and lesions not to be
missed. British Journal of Community Nursing 2004 (Suppl 5): S23–S28.
Todhunter, J. (2019). Understanding the dierential diagnosis of leg ulcers:
focus on atypical leg ulcers. Journal of Community Nursing 33(1): 29–37.
Trent, J.T. and Kirsner, R.S. (2003). Wounds and malignancy. Advances in
Skin & Wound Care 16 (1): 31–34.
Trent, J.T. and Kirsner, R.S. (2004). Leg ulcers in sickle cell disease. Advances
in Skin Wound Care 17: 410–416.
UK Health Security Agency (UKHSA) (2022). People who inject drugs: HIV
and viral hepatitis monitoring. https://www.gov.uk/government/publi
cations/people- who- inject- drugs- hiv- and- viral- hepatitis- monitoring
UK Health Security Agency, Public Health Agency Northern Ireland, Public
Health Scotland and Public Health Wales (UKHSA) (2023). Shooting
up: infections and other injecting- related harms among people who
- an underreported multicausal complication with consid six patients and review of the
Phlebolymphology
Fossuo, C.N., Millsop, J.W., Johnson, M.A. etal. (2018). Ulcerated
本书版权归John Wiley & Sons Inc.所有
Atypical Causes of Leg Ulceration 187
https://t.me/medicina_free
inject drugs in the UK. Data to end of 2021. London: UK Health Security
Agency. https://www.gov.uk/government/publications/shootinginfections-
Vaiman, M., Lazarovitch, T., Heller, L., and Lotan, G. (2015). Ecthyma
gangrenosum and ecthyma Journal of Clinical Microbiology & Infectious Diseases 34(4): 633–639.
Volkmann, E.R., Andreasson, K., and Smith, V. (2023). Systemic
Lancet 401: 304–318.
Walker, S.L. and Lockwood, D.N.J. (2007). Leprosy. Clinics in Dermatology
25: 165–172.
Weinstien, D., Araujo, T., and Kirsner, S. (2012). Atypical wounds. In: Wound
Care Essentials Practice Principles, 3e (ed. S. Baranoski and E. Ayello),
492–493. Philadelphia, PA: Wolters Kluwer/Lippincott Williams
and Wilkins.
White, R. (1999). A new standard for the nursing assessment of leg ulcers.
British Journal of Nursing 8 (19): 1272–1282.
Wounds International (2012). International Case Series: Using Actisorb. Lon-
don: Wounds International.
Wounds UK (2016). Best Practice Statement: Holistic Management of Venous
Leg Ulceration. London: Wounds UK.
Wounds UK (2018). Best Practice Statement: Improving Holistic Assessment of
Chronic Wounds. London: Wounds UK.
Wounds UK (2019). Best Practice Statement: Ankle Brachial Pressure Index
(ABPI) in Practice. London: Wounds UK.
Young, T. (2019). Rheumatoid arthritis and its impact on ulceration and heal-
ing. Wounds UK 15 (4): 40–43.
Youse, J., Novosad, S., and Winithrop, K. (2016). Infection risk and safety of
corticosteroid use. Rheumatic Disease Clinics of North America
42(1): 157–176.
Zhang, D. and McMullin, G. (2022). Necrobiosis lipoidica: a review of man-
agement and the role of compression. Wound Practice and Research
30(1): 11–15.
Zhou, Z., Zhang, Z.K., and Liu, T.H. (2015). Erosive pustular dermatosis of
the leg mimicking lower limb cellulitis. Clinical and Experimental
Dermatology 40 (8): 865–867.
among- people- who- inject- drugs- in- the- uk
like lesions: review article. European
up-
sclerosis.
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CHAPTER
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4
Musculoskeletal Factors
inLeg Ulcers
Assessment andManagement
RONA FRANCES CAMPBELL
here is a growing recognition that sub- optimal movement,
T
reduced mobility and impaired biomechanical function have an
impact on the development and longevity of lower limb complications that relate to chronic venous disease (CVD), venous leg ulcers
(VLUs) and lymphoedema (Araujo et al. 2016; Farrelly 2018;
Meulendijks etal.2020a,2020b).
Enhancing patient movement and addressing musculoskeletal
(MSK) and biomechanical concerns is key in optimising compression
therapy during an episode of ulceration. Optimal movement and
mobility also helps to mitigate complications like peripheral oedema
and impaired joint mobility (Wounds2016).
Optimal physical function reects adequate motor control, physical tness and the ability to mobilise freely on a regular basis (Langhammer et al.2018). Inactivity or immobility, whether because of
pain, injury, systemic disease, neuropathy, nondisease or the ageing process, can lead to sub- optimal movement and
changes in physical and biomechanical function that can increase
venous hypertension (Langhammer etal.2018).
neurological MSK
Lower Limb and Leg Ulcer Assessment and Management, First Edition.
Edited by Aby Mitchell, Georgina Ritchie, and Alison Hopkins.
© 2024 John Wiley & Sons Ltd. Published 2024 by John Wiley & Sons Ltd.
188
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Musculoskeletal Factors in Leg Ulcers 189
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People with CVD and VLUs are known to present with biomechanical issues, for example impairment in ankle joint movement or
gait dysfunction (Figure 4.1) (Back et al. 1995; Clarke-
Moloney
etal. 2007; Araujo et al.2016). These issues can result in adverse
changes in important physiological processes that ensure lower limb
health and venous return, namely the veno- muscular pumps (VMPs)
(Uhl and Gillot2015; NICE2021). The VMPs are important anatomical pumps in the lower limb, and they help mediate haemodynamic
homeostasis within the circulatory system and aid venous return
when activated through regular MSK movement (Uhl and Gillot2015). An important VMP in the lower limb is the calf muscle
pump (CMP). Failure and dysfunction of this pump through a reduction in ankle joint range of motion (ROM) and adverse changes in
gait are major contributory factors in the development and chronicity
of CVD and VLUs (Lattimer etal.2017).
This chapter will examine the factors that inuence mobility,
lower limb biomechanical function and the inuence of sub- optimal
gait, with a focus on the lower limb VMPs and ankle joint ROM.
Ambulatory
Venous Hypertension
Abnormal Muscle
Pump Function
Neuropathy
Decreased Mobility,
Range of Motion
FIGURE 4.1 Biomechanical factors that inuence venous leg ulceration.
Source: Shiman etal.2009/John Wiley & Sons. Reproduced with
permission.
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Gait
Abnormalities
Pain
Venous Leg
Ulceration
190 MUSCULOSKELETAL FACTORS IN LEG ULCERS
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Understanding how these biomechanical factors aect the management of patients with CVD and VLUs is vital. These factors relating
to mobility impairment are known to have a negative inuence on
the onset and progress of CVD, VLUs and wound healing (Padberg
etal.2004). Moreover, a loss in mobility is known to have an impact
on quality of life (QoL) (Meulendijks etal.2020b).
RISK FACTORS
There are known non- modiable established risk factors in patients
who have CVD and VLUs, such as age, sex and family history
(NICE2021). However, there is a sub- section of modiable risk factors that relate to mobility and the biomechanical function (refer to
risk factors in Chapter5) for those who have CVD and VLUs which
are poorly understood, and these relate to sub- optimal mobility and
biomechanical and gait dysfunction.
During holistic lower limb assessment, screening for risk factors
that relate to an individual’s mobility and biomechanical function in
conjunction with those relating to VLUs is important for optimal
clinical outcomes, as poor mobility can have an impact on many
areas within wound care management (O’Brien et al.2014; Smith
etal.2018). However, screening for mobility risk factors for patients
who have VLUs may be perceived as challenging for a nurse when
evidence suggests that delivering essential care can in some cases be
dicult in a busy clinical setting (Guest etal. 2018). Moreover,
biomechanical and mobility factors are not always recognised as
important risk factors for the development and chronicity of VLUs
within wound care management (Farrelly2018).
A poorly recognised mobility risk factor for the development and
chronicity of VLUs is CMP dysfunction. The CMP is in the lower,
posterior leg and is one of the important VMPs in the lower limb and
foot. The VMPs are responsible for 90% of the venous return from
the lower limb to the trunk (Williams et al. 2014). The CMP is
responsible for approximately 65% of the net venous blood return
within the lower limb, which is enabled through adequate movement at the ankle (Williams etal.2014).
CMP dysfunction is not only a risk factor for VLUs, but also for
deep vein thrombosis (DVT), and is an independent predictor of
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Musculoskeletal Factors in Leg Ulcers 191
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all- cause mortality (Araki etal.1994; Back etal.1995; Milic etal.2009;
Halkar et al. 2020). Therefore, recognition of CMP dysfunction is
important not only within the context of VLU management, but in
relation to the overall health of the patient.
A major biomechanical risk factor inuencing CMP dysfunction
is the loss of ankle joint ROM (Back etal.1995; de Souza etal.2022).
Research suggests that when ankle joint ROM is reduced there is
an increased risk of developing an ulceration (Table 4.1) (Araki
etal.1994). Once an ulcer has developed, the episode of wound healing can be prolonged compared to people with adequate ROM when
using compression bandaging (Barwell etal.2000). When movement
at the ankle is impaired, there is a reduction in the functional
TABLE 4.1
avenous leg ulcer.
Risk factor Explanation
Immobility Increased risk of venous hypertension
Limited ankle range of
motion (ROM)
Sedentary lifestyle Obesity
History of leg frac-
ture or trauma
Lower limb dysfunction/
structural deformities
Underlying
musculoskeletal disease
Biomechanical risk factors that may contribute todeveloping
and oedema
Reduction in joint ROM
Sarcopenia
Obesity
Calf muscle pump (CMP) dysfunction
Impact on gait
Fixed joint position
Gait impairment
Impact on CMP function
Impaired gait
Damage to the venous and lymphatic anatomy
Impaired joint ROM
Leg length discrepancy
Pelvic obliquity
Genu valgum/recuvartum
Highly pronated or supinated foot postures
Diseases that cause issues with balance and
proprioception
Diseases that result in structural deformities
Diseases that result in gait dysfunction
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