Many studies describe the use of the Ilizarov ring fixator for lower limb lengthening and for the management of the 3-dimensional lower limb deformities in achondroplasia, and most confirm the efficacy of this technique. However, long term follow up of these achondroplastic patients is lacking. Most studies have focused on magnitude of lengthening, treatment time required and complications, but no study has analyzed the long term postoperative condition of these patients using an objective, functional method such as gait analysis.

Nineteen (19) achondroplastic patients, 12 males and 7 females, aged 19–38 years (mean 27.3 y) who have undergone tibia and femur lengthening, using the Ilizarov method, at the age of 9–19 years (mean 12.6 y), were evaluated 5–19 years (mean 10.1 y) after their last surgery, using 3-dimensional gait analysis. Nineteen (19) normal, height-matched subjects were used as controls. The VICON Nexus 8 Camera System was used to accurately measure spatiotemporal characteristics (walking velocity, stride length, step length, cadence) and kinematics (range of motion) of lower limb joints. Statistical comparison of deformity parameters between achondroplastic patients and normal population was done using the student t- test. A level of p<0.05 was considered statistically significant.

Walking velocity, step length and stride length were statistically significantly decreased (p<0.05) in achondroplastic patients compared to normal population values. The achondroplastic group presented with excessive anterior pelvic tilt (mean 21.9^o± 7.3), excessive pelvic rotation (range 28.7^o±7.8), decreased hip extension (mean 1.8^o±10.1) and decreased plantar flexion (mean 17.1^o±5.1) when compared to normal controls. There was no statistically significant difference in the knee kinematics between the operated achondroplastic patients and normal controls.

The achondroplastic patients present decreased values in their spatiotemporal characteristics compared to the normal subjects because, despite the height gain, their lower limbs remain shorter. Their excessive anterior pelvic tilt is attributed to their lordosis. Their excessive forward pelvic rotation is an attempt to increase stride and step length. The decreased hip extension is due to their anterior pelvic tilt. The correction of these patients genu varum restored knee kinematics to normal. In order to address the hip and pelvis deformities a proximal femoral osteotomy should be considered.

The Ilizarov method provides functional height gain and substantially corrects the three-dimensional lower limb deformities of achondroplastic patients especially around the knee joint but more planning needs to be implemented when the system is applied to correct the disease specific deformities of the hip and pelvis. Gait analysis is an objective tool that can be used to address these design issues.

The aim of this retrospective study is to isolate the cases of “overuse syndromes” in young athletes in whom the initial diagnosis proved wrong.

During six-year period 2002 – 2007, 28 young athletes (16 boys and 12 girls) aged 9.6 years (ranged from 6.5 to 14 years), suffering an underlying disease that had initially attributed to “overuse syndromes”, were treated in our Department. In all of the cases the history was misleading and the clinical examination was precarious, while the x-ray examination proved to be unclear. The remaining imaging exams led finally to the correct diagnosis that was confirmed in the operating room or via the biopsy.

In 4 cases a slipped capital femoral epiphysis was ascertained. In other cases we verified an osteochondritis dissecans of femoral condyle or talus (4), an osteoid osteoma (4), Perthes disease (3), osteochondromas (3), calcaneonavicular synchondrosis (3), hemangioma (2), discoid meniscus (1), herpes zoster along the sciatic nerve (1), aneurysmal cyst of fibula (1), accessory navicular (1), and osteosarcoma of fibula (1).

Overuse syndromes in young athletes should be treated with skepticism because another more serious disease may be hidden behind the symptoms and clinical signs. The children and adolescents have a skeleton that grows constantly and develops a special pathogenesis and this fact must be always kept in mind of parents, trainers and therapists. The young subjects who expect to be integrated in the athletic family should be previously examined by Pediatrician and Pediatric Orthopedic Surgeon so that a congenital anomaly or an acquired disease will be diagnosed in time.