The Levi's 514 Slim Straight generally have a 17" (43.18cm) leg opening. The leg opening may vary by waist size. It has a straight leg fit, between snug and baggy.

The Levi's 511 Skinny have a 14.5" (36.83cm) leg opening.It has a slim/skinny leg fit, close at the thigh and straight to the ankle.

Leg pain at night can make sleeping tough. These night time leg pains are commonly referred to as restless leg syndrome or RLS and are caused by a variety of underlying conditions. Many treatments are available to alleviate and increase the severity of this type of leg pain.

Although restless leg syndrome is not well understood, it is a common cause of night time leg pain. These pains are not noticeable until lying still. The pain worsens over the course of the night and is sometimes very painful. RLS is not the only thing that causes pain while sleeping. In less severe cases, these pains are the result of overworked muscles cramping up. This does not produce night after night effects like RLS.

The causes are restless leg syndrome are not known at this time, but correlations exist between RLS and features found in certain populations of people. It is often associated with pregnancy, obesity, anemia, smoking, diabetes and nerve disease. Caffeine and alcohol use also have correlations to RLS. In some cases, RLS is even genetically inherited from your parents.

When attempting to treat restless leg syndrome, doctors first treat possible underlying disorders that may cause it. Blood testing can detect syndromes such as anemia. Varicose veins also can cause RLS and need correction by surgery to repair leg circulation. Eliminating or cutting back on alcohol and caffeine consumption often reduce the symptoms of RLS. Increased activity and exercise help diminish the effects of RLS. There are medications for RLS available and many are extremely effective. Natural supplements such as iron are helpful, but prescription drugs are recommended for more extreme cases. These include Valium, Neurotonin, Restoril and Klonopin.

If you are experiencing night time leg pain and symptoms of restless leg syndrome consult your doctor. Diet changes, exercise and medication are proven effective at treating and alleviating this type of leg pain.

The most common bones treated with lengthening procedures are the bones of the leg, the tibia and the femur.

Surgical treatment may be recommended for severe unequal leg lengths caused by:

• poliomyelitis and cerebral palsy
• small, weak (atrophied) muscles or short, tight (spastic) muscles may cause deformities and prevent normal leg growth
• hip diseases such as Legg-Perthes disease
• previous injuries or bone fractures that may stimulate excessive bone growth
• abnormal spinal curvatures (scoliosis)
• birth defects (congenital deformities) of bones, joints, muscles, tendons, or ligaments

While the child is deep asleep and pain-free (using general anesthesia), the surgeons carefully study the blood vessels and blood supply to the bone. An incision is made in the bone to be lengthened; usually the lower leg bone (tibia) or upper leg bone (femur). Metal pins or screws are inserted into and through the skin and bone above and below the bone incision and the skin incision is stitched closed. A metal device (such as an Ilizarov device) is attached to the screws in the bone and will be used later to gradually "crank" the cut bone apart, creating a space between the ends of the cut bone, which heals to form new bone. The lengthening device is used very gradually, lengthening the bone in extremely small steps, usually over the course of several months.

The device used to lengthen the leg after placement of the pins usually must stay in place for many months. The leg is gradually lengthened over this time, and the patient is usually able to walk with the device in place. Multiple surgeries are usually required to effect significant lengthening of the limb.

Review Date: 11/12/2010

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Determining the cause of leg pain in children is tricky, but it is possible to watch for signs and symptoms that can signal some of the most common causes. Even though the child may not have the ability to accurately describe the pain's intensity or area of origin - knee pain can sometimes start in the hip, for example - it is important to try to get a good description of the kind of pain the child is experiencing.

One of the most common causes of leg pain in children is attributable to growing pains. This type of leg pain often occurs late in the day or in the middle of the night. Gently massaging the muscle often helps to alleviate the typical discomfort of growing pains. In the absence of a fever or other symptoms, massage is also one way to rule out other causes. If the pain is due to injury or another medical condition, touching the area often makes the pain worse.

Among the other most common causes of childhood leg pain, injury tops the list. Some kinds of bone fractures, sometimes called "toddler's fractures," are potentially the result of a simple fall and are difficult to see on an x-ray. Muscle pain is also a common symptom of a virus such as the flu, but this type of pain is limited to muscle tissue. Pain in the joints could indicate an infection like septic arthritis; in this case, the joint is typically warm and swollen, and the child may refuse to move or place any weight on the affected leg.

If any symptoms other than leg pain are present, the safest choice is to have the child evaluated by a doctor. Most conditions require diagnosis and treatment by a qualified medical professional.

Leg lengthening and shortening are types of surgery to treat children who have legs of unequal lengths, usually with differences of 1 inch or more.

These procedures may:

• Lengthen an abnormally short leg
• Shorten an abnormally long leg
• Limit growth of a normal leg to allow a short leg to grow to a matching length

Epiphysiodesis; Epiphyseal arrest; Correction of unequal bone length; Bone lengthening; Bone shortening; Femoral lengthening; Femoral shortening

BONE LENGTHENING

Lengthening an abnormally short leg may be recommended for children whose bones are still growing. This series of treatments involves several surgical procedures, a lengthy convalescence period, and considerable risks -- but it can add up to 6 inches of length to a leg.

While the child is under general anesthesia, the bone to be lengthened is cut. Metal pins or screws are inserted through the skin and into the bone.

Pins are placed above and below the cut in the bone, and the skin incision is stitched closed.

A metal device (usually some sort of external frame) is attached to the pins in the bone and will be used later to gradually pull the cut bone apart, creating a space between the ends of the cut bone that will fill in with new bone. The lengthening device is used very gradually to ensure adequate filling of the bone and stretching of the soft tissues.

Later, when the leg has reached the desired length and has healed (usually after several months), another surgical procedure will be done to remove the pins.

Because the pins or screws are inserted through the skin into the bone, special care of the pin sites is important to prevent infection. Also, because the blood vessels, muscles, and skin are stretched with each lengthening, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is necessary to prevent circulatory, muscular, or nerve damage.

BONE SHORTENING

Shortening a longer leg may be recommended for children whose bones are no longer growing. This is a technically complicated surgery that can produce a very precise degree of correction.

While the child is under general anesthesia, the bone to be shortened is cut and a section of bone is removed. The ends of the cut bone will be joined and a metal plate with screws or a nail down the center of the bone is placed across the bone incision to hold it in place during healing.

Because the blood vessels, muscles, and skin are involved, careful and frequent checking of the skin color, temperature, and sensation of the foot and toes is necessary to prevent circulatory, muscular, or nerve damage.

BONE GROWTH RESTRICTION

Bone growth takes place at the growth plates (physes) at each end of long bones. Restricting bone growth may be recommended for children whose bones are still growing. It is used to restrict the growth of a longer bone to allow the shorter bone to continue to grow to match its length.

While the child is under general anesthesia, the surgeons make an incision over the growth plate at the end of the bone in the longer leg.

Destroying the growth plate by scraping or drilling it (epiphysiodesis or physeal arrest) will restrict further growth at that growth plate. Proper timing of this surgical treatment is important to assure good results.

REMOVAL OF IMPLANTED METAL DEVICES

Metal pins, screws, staples, or plates may be used to stabilize bone during healing. Most orthopedic surgeons prefer to wait several months to a year before removing any large metal implants. Removal of implanted devices requires another surgical procedure using general anesthesia.

Surgical treatment may be recommended for severe unequal leg lengths caused by the following:

• Poliomyelitisand cerebral palsy
• Small, weak (atrophied) muscles or short, tight (spastic) muscles which may cause deformities and prevent normal leg growth
• Hip diseases such as Legg-Perthes disease
• Previous injuries or bone fractures that may stimulate excessive bone growth
• Birth defects (congenital deformities) of bones, joints, muscles, tendons, or ligaments

In general, leg lengthening is considered for large differences (more than 5 cm). Leg shortening or restricting is considered for smaller differences (less than 5 cm). Lengthening is also considered more often when the patient is short to begin with.

Risks for any anesthesia include:

• Reactions to medications
• Problems breathing

Risks for any surgery include:

• Bleeding
• Infection

Additional risks include:

• Bone infection (osteomyelitis)
• Injury to blood vessels
• Poor bone healing
• Nerve damage

Epiphysiodesis (bone growth restriction) is usually successful when performed at the correct time in the growth period, though it may cause an undesirable short stature.

Bone shortening may achieve more precise correction than epiphysiodesis, but requires much longer convalescence.

Bone lengthening is completely successful only 40% of the time and has a much higher rate of complications.

With bone growth restriction, hospitalization of up to a week is common. Sometimes a cast is placed on the leg for 3 - 4 weeks. Healing is complete in 8 - 12 weeks, at which time full activities can be resumed.

With bone shortening, 2 - 3 weeks of hospitalization with bedrest is usual. Sometimes a cast is placed on the leg for 3 - 4 weeks. Muscle weakness is common, and muscle-strengthening exercises are started soon after surgery. Crutches are used for 6 - 8 weeks. Some children require 6 - 12 months to regain normal knee control and function. The intramedullary (inside the bone) rod is removed at 1 year.

With bone lengthening, hospitalization lasts a week or longer. The time that the lengthening device is in use depends on the amount of lengthening to be achieved. Intensive physical therapy is required to maintain normal range of motion. Frequent visits to the doctor are necessary to adjust the lengthening device. Meticulous care of the pins holding the device is essential to prevent infection. Healing time of the bone is determined by the amount of lengthening. For each centimeter of lengthening, 36 days of healing is allotted.

Following removal of the device, activities are usually restricted for several weeks to allow for healing of the holes in the bone where the pins were. This minimizes the risk of breaking the bone through these holes until healing has occurred.

Hosalkar HS, Gholve PA, Spiegel DA. Leg-length discrepancy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 675.

Leg or foot amputation is the removal of a leg, foot or toes from the body. These body parts are called extremities. Amputations are done either by surgery, or they occur by accident or trauma to the body.

Amputation - foot; Amputation - leg; Trans-metatarsal amputation; Below knee amputation; BK amputation; Above knee amputation; AK amputation; Trans-femoral amputation; Trans-tibial amputation

Reasons for having an amputation of a lower limb are:

• Severe trauma to the limb that is caused by an accident
• Poor blood flow to the limb
• Infections that do not go away or become worse and cannot be controlled or healed
• Tumors of the lower limb
• Severe burns or severe frostbite
• Wounds that do not heal

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Bleeding

Risks for this surgery are:

• A feeling that the limb is still there. This is called phantom sensation. Sometimes this feeling can be painful. That is called phantom pain.
• The joint closest to the part that is amputated loses its range of motion, making it hard to move. This is called joint contracture.
• Infection of the skin or bone.
• The amputation wound does not heal properly.

When your amputation is planned, you will be asked to do certain things to prepare for it. Always tell your doctor or nurse:

• What drugs you are taking, even drugs or herbs you bought without a prescription
• If you have been drinking a lot of alcohol

During the days before your surgery, you may be asked to stop taking aspirin, ibuprofen (such as Advil or Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.

Ask your doctor which drugs you should still take on the day of your surgery. If you smoke, stop.

If you have diabetes, follow your diet and take your medicines as usual until the day of surgery.

On the day of the surgery, most times you will be asked not to drink or eat anything for 8 to 12 hours before your surgery.

Take your drugs your doctor told you to take with a small sip of water. If you have diabetes, follow the directions your doctor gave you.

Prepare your home before surgery:

• What help will you need when you come home from the hospital?
• Do you have a family member, friend, or neighbor who can help you? If not, ask your doctor or nurse for help planning for someone to come into your home.
• Is your bathroom and the rest of your house safe for you to move around in?
• Will you be able to get in and out of your home safely?

The end of your leg, or stump, will have a dressing and bandage that will remain on for 3 or more days. You may have pain for the first few days. You will be able to take pain medicine as you need them.

You may have a tube that drains fluid from the wound. This will be taken out after a few days.

Before leaving the hospital, you will begin learning how to:

• Use a wheelchair or a walker
• Stretch your muscles to make them stronger
• Strengthen your arms and legs
• Begin walking with a walking aid and parallel bars
• Start moving around the bed and into the chair in your hospital room
• Keep your joints mobile
• Sit or lay in different positions to keep your joints from becoming stiff
• Control swelling in the area around your amputation
• Properly put weight on your leg. You'll be told how much weight to put on your leg. You may not be allowed to put weight on your leg until the stump is fully healed.

Fitting for prosthesis, a manmade part to replace your limb, may occur when:

• Your amputation wound is mostly healed
• Your stump is no longer tender to the touch

Your recovery and ability to function after an amputation depend on many things. Some of these are the reason for the amputation, whether you have diabetes or poor blood flow, and your age.

Heck RK. General principles of amputations. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 9.

Review Date: 12/10/2010

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Pain - hip

Hip-related pain is not always felt directly over the hip. Instead, you may feel it in the middle of your thigh or in your groin. Similarly, pain you feel in the hip may actually reflect a problem in your back, rather than your hip itself.

See: Low back pain

Hip fractures are a significant and serious cause of sudden hip pain. Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

A hip fracture can change the quality of your life significantly. Fewer than 50% of those with a hip fracture return to their former level of activity. In addition, while recovering from a hip fracture, several possible complications can be life-threatening. These include pneumonia and a blood clot in the leg, which can dislodge and travel to cause a clot in the lungs. Both are due to immobility following a hip fracture and hip surgery.

Other possible causes of hip pain include:

• Arthritis -- often felt in the front part of your thigh or in your groin
• Osteonecrosisof the hip
• Trochanteric bursitis -- hurts when you get up from a chair, walk, climb stairs, and drive
• Tendinitis from repetitive or strenuous activity
• Strain or sprain
• Low-back pain such as sciatica
• Infection

• Try to avoid activities that aggravate the pain.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Sleep on your non-painful side with a pillow between your legs.

A hip fracture is considered a medical emergency. Therefore, if suspected, you should get medical help right away.

As the pain improves, gradually begin to exercise. It is best to work with a physical therapist to learn proper exercises and how to advance your activity. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining your hip joint. However, swimming does not build bone mass. When you are ready (a physical therapist can help determine that), slowly and carefully resume walking or another activity against the resistance of gravity.

Go to a hospital or call 911 if:

• Your hip pain is caused by a fall or other injury
• Your hip is misshapen, badly bruised, or bleeding
• You are unable to move your hip or bear any weight

Call your doctor if:

• Your hip is still painful after 1 week of home treatment
• You also have a fever or rash
• You have sudden hip pain, plus sickle cell anemia or long-term steroid use
• You have pain in both hips or other joints

Your health care provider will perform a physical examination, with careful attention to your hips, thighs, back, and gait.

To help diagnose the cause of the problem, your doctor will ask medical history questions, such as:

• Do you have pain in one or both hips?
• Do you have pain elsewhere like your lower back or thigh?
• Do you have pain in other joints?
• Did your pain begin suddenly, or slowly and mildly?
• Did the pain begin after an injury, fall, or accident?
• Does any particular activity make the pain worse?
• Have you done anything to try to relieve the pain? If so, what helps?
• Are you able to walk and bear weight?
• What other medical problems do you have? Osteoporosis or other signs of bone loss? Sickle cell anemia?
• Do you take any medications? If so, which ones? If on steroids, for how long have you been on them?

X-rays of the hip may be necessary.

Your doctor may tell you to take a higher dose of over-the-counter medication, or give you a prescription anti-inflammatory medication.

Surgical repair or hip replacement may be recommended for osteonecrosis. Hip replacement is necessary for hip fracture and severe arthritis. With current technology, an artificial hip should last at least 10 to 15 years. Expect recovery from surgery to take at least 6 weeks. Plates and screws may be used to fix fractures around the hip.

Complications can occur from surgery. A blood clot in the leg is the most common complication, which can lead to a blood clot in the lungs.

• Avoid activities that raise one of your hips above the other for extended periods of time, like running on an uneven surface. Running on a treadmill can keep your hips level.
• Warm up before exercising and cool down afterward. Stretch your hips, low back, and thighs.
• Avoid falls.
• Wear hip pads for contact sports like football and hockey. For those at high risk for a hip fracture, pads with a streamline design can be worn in undergarments.
• Learn how to prevent osteoporosis.

Daboy G. Miscellaneous nontraumatic disorders. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 25.

LeVelle DG. Fractures and dislocations of the hip. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 52.

Cornell CN, Sculco TP. Orthopedic disorders. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 37.

Wong TK, Lee RY. Effects of low back pain on the relationship between the movements of the lumbar spine and hip. Hum Mov Sci. 2004; 23(1): 21-34.

Dohnke B, Knauper B, Muller-Fahrnow W. Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip joint replacement. Arthritis Rheum. 2005; 53(4): 585-592.

Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise program for older adults with osteoarthritis of the hip. J Rheumatol. 2005; 32(6): 1106-1113.

Ingredients

• 1 Bone-in leg of spring lamb
• 5 Garlic cloves; peeled,
• cut into 1/4-in slivers 2 tb Olive oil
• 10 md Onions; finely sliced
• 1/2 tb Chopped fresh thyme leaves
• OR- 1 ts -Dried thyme
• 1/2 tb Salt; or as desired
• White pepper 2 c Cooked rice
• 1/2 c Whipping cream
• 1 ts Nutmeg, freshly ground

PREHEAT OVEN TO 400F. Trim excess fat from the outside of the leg, leaving only a thin layer. Using a small knife, poke holes in the meat and stuff in slivers of garlic. Rub the surface of the lamb with olive oil. Mound onions and thyme in the middle of a roasting pan. Sprinkle the lamb with salt and pepper and place it, fat side down, on the onions. Place in the oven, reduce heat to 350F and roast 1 hour. Turn the lamb fat side up and return to the oven. Roast another 20-to-30 minutes for medium-rare or about 20 minutes per pound. A meat thermometer should read 145F for medium rare. Remove the pan from the oven and place the lamb on a cutting board. Let rest 15 minutes before carving. Scrape the onions into a food processor, add the rice, cream, nutmeg and desired salt, and pulse, scraping down the sides of the bowl, until a lumpy smooth puree is attained. When it's time to serve dinner, transfer the puree to a vegetable dish. Slice the lamb and arrange on a meat platter.