Contralateral Lower Extremity Pain in Pediatric and Young Adult Sports Participants with Lower Extremity Amputation/Transverse Limb Deficiencies

Background: Contralateral lower extremity (LE) pain and osteoarthritis are common in adults with unilateral LE amputation, thought to be secondary to overuse. Contralateral LE pain in pediatric-onset LE amputation or transverse limb deficiency (“LE amputation”) is understudied. We suspect that this population also experiences contralateral LE pain. We sought to discover the prevalence of contralateral LE pain in young sports participants with pediatric-onset of unilateral LE amputation. Hypothesis: Contralateral LE pain is meaningfully prevalent in this population. Methods: PHYSICALL (Physical Health and Youth Sports in Congenital and Amputated Lower Limb Deficiency) was a multi-site cross-sectional study that surveyed patients with LE amputation ages 8-26 across 6 academic centers with specialty pediatric care of patients with LE amputation. The questionnaire addressed sports participation in all participants and contralateral LE pain in individuals with unilateral LE amputation. Data was collected 11/2021-8/2023. We utilized the PHYSICALL dataset to evaluate contralateral LE pain in pediatric (8-17 years old) and young adult (YA) (18-26 years old) sports participants with unilateral LE amputation. We defined “sports participants” as individuals who reported playing sports between March 2021 and the questionnaire date. Inclusion/exclusion is in Figure 1. For individuals who reported a history of pain, pain was assessed at rest, with walking, and with running using the Wong Baker FACES scale (1-10). Descriptive statistics were utilized. Means are presented with standard deviations. Results: Of 151 records, 45 (28 pediatric, 17 YA) met inclusion/exclusion criteria. Mean age was 16 ±4.4 (range 9-25), with 56% male. History of contralateral LE pain was reported in 75% of the pediatric group (PG) and 76% of YAs. Knee and foot/ankle pain were most common (Table 1). History of contralateral knee pain was reported in 46% of the PG and 41% of YAs, while history of contralateral foot/ankle pain was reported in 29% and 53%, respectively. PG mean knee pain scores were 2.4 (±2.0) at rest and 2.3 (±2.0) with running. PG ankle pain averaged 2.0 (±2.1) at rest and 3.3 (±2.6) with running. Among YAs, mean knee pain was 1.6 (±2.0) at rest and 3.4 (±2.2) with running, while ankle pain averaged 1.6 (±2.8) at rest and 3.3 (±2.6) with running. Conclusion: History of contralateral LE pain, particularly knee and foot/ankle pain, is common in pediatric and YA sports participants with unilateral LE amputation. Prospective research is needed to characterize this pain to better understand its relation to overuse and to direct early identification, treatment, and prevention strategies.