Long-term Pathological Gait Pattern Changes After Talus Fractures - Dynamic Measurements with a New Insole

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 Jan 4

PMID 29297103

Citations 6

Authors

Benedikt J Braun

Patrick Pelz

Nils T Veith

Mika Rollmann

Moritz Klein

Steven C Herath

Jorg H Holstein

Tim Pohlemann

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of the current study was to describe long-term gait changes after talus fractures, identify patterns associated with poor outcome and discuss possible treatment options based on dynamic gait analysis.

Methods: Twenty-seven patients were followed-up clinically and via gait analysis after talus fracture osteosynthesis. Continuous dynamic pedobarography with a gait analysis insole was performed on a standardized parcours consisting of different gait tasks and matched to the outcome.

Results: Mean follow-up was 78.3 months (range 21-150), mean AOFAS and Olerud-Molander scores 66 (range 20-100) and 54 (range 15-100). Significant correlations between fracture classification and osteoarthritis (Hawkins: r = 0.67 / Marti-Weber: r = 0.5) as well as several gait differences between injured and healthy foot with correlations to outcome were seen: decreased step load-integral/maximum-load; associations between centre-of-pressure displacement and outcome as well as between temporospatial measures and outcome. Overall, pressure-distribution was lateralized in patients with subtalar joint injury (Δ: 0.5765 N/cm, p = 0.0475).

Conclusions: Talus fractures lead to chronic gait changes and restricted function. Dynamic pedobarography can identify patterns associated with poor results. The observed gait patterns suggest that changes can be addressed by physical therapy and customized orthoses to improve overall outcome. The presented insole and measurement protocol are immediately feasible as a diagnostic and rehabilitation aid.

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References

Deleanu B, Prejbeanu R, Crisan D, Predescu V, Popa I, Poenaru D . Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures. Int Orthop. 2015; 39(7):1411-5. DOI: 10.1007/s00264-015-2691-0. View

Wall 3rd C, Wrisley D, Statler K . Vibrotactile tilt feedback improves dynamic gait index: a fall risk indicator in older adults. Gait Posture. 2009; 30(1):16-21. PMC: 2752821. DOI: 10.1016/j.gaitpost.2009.02.019. View

Piriou P, Culpan P, Mullins M, Cardon J, Pozzi D, Judet T . Ankle replacement versus arthrodesis: a comparative gait analysis study. Foot Ankle Int. 2008; 29(1):3-9. DOI: 10.3113/FAI.2008.0003. View

BARGON G, Henkemeyer H . [Long-term radiological and clinical observations following surgery for tibio-fibular syndesmosis after fractures of the upper ankle joint (author's transl)]. Rofo. 1977; 126(6):542-5. DOI: 10.1055/s-0029-1230633. View

Canale S, KELLY Jr F . Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978; 60(2):143-56. View

Jansen H, Fenwick A, Doht S, Frey S, Meffert R . Clinical outcome and changes in gait pattern after pilon fractures. Int Orthop. 2012; 37(1):51-8. PMC: 3532654. DOI: 10.1007/s00264-012-1716-1. View

Prada-Canizares A, Aunon-Martin I, Vila Y Rico J, Pretell-Mazzini J . Subtalar dislocation: management and prognosis for an uncommon orthopaedic condition. Int Orthop. 2015; 40(5):999-1007. DOI: 10.1007/s00264-015-2910-8. View

Fournier A, Barba N, Steiger V, Lourdais A, Frin J, Williams T . Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res. 2012; 98(4 Suppl):S48-55. DOI: 10.1016/j.otsr.2012.04.012. View

Luximon Y, Cong Y, Luximon A, Zhang M . Effects of heel base size, walking speed, and slope angle on center of pressure trajectory and plantar pressure when wearing high-heeled shoes. Hum Mov Sci. 2015; 41:307-19. DOI: 10.1016/j.humov.2015.04.003. View

10.

Ahmad J, Raikin S . Current concepts review: talar fractures. Foot Ankle Int. 2006; 27(6):475-82. DOI: 10.1177/107110070602700616. View

11.

Mayich D, Novak A, Vena D, Daniels T, Brodsky J . Gait analysis in orthopedic foot and ankle surgery--topical review, part 1: principles and uses of gait analysis. Foot Ankle Int. 2013; 35(1):80-90. DOI: 10.1177/1071100713508394. View

12.

Robain G, Valentini F, Renard-Deniel S, Chennevelle J, Piera J . [A baropodometric parameter to analyze the gait of hemiparetic patients: the path of center of pressure]. Ann Readapt Med Phys. 2006; 49(8):609-13. DOI: 10.1016/j.annrmp.2006.05.002. View

13.

Baratto L, Morasso P, Re C, Spada G . A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques. Motor Control. 2002; 6(3):246-70. DOI: 10.1123/mcj.6.3.246. View

14.

Wheeler J, Shull P, Besier T . Real-time knee adduction moment feedback for gait retraining through visual and tactile displays. J Biomech Eng. 2011; 133(4):041007. DOI: 10.1115/1.4003621. View

15.

Pajenda G, Vecsei V, Reddy B, Heinz T . Treatment of talar neck fractures: clinical results of 50 patients. J Foot Ankle Surg. 2000; 39(6):365-75. DOI: 10.1016/s1067-2516(00)80072-1. View

16.

Sanders D, Busam M, Hattwick E, Edwards J, McAndrew M, Johnson K . Functional outcomes following displaced talar neck fractures. J Orthop Trauma. 2004; 18(5):265-70. DOI: 10.1097/00005131-200405000-00001. View

17.

Braun B, Veith N, Rollmann M, Orth M, Fritz T, Herath S . Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole. Int Orthop. 2017; 41(8):1507-1512. DOI: 10.1007/s00264-017-3481-7. View

18.

Rammelt S, Biewener A, Grass R, Zwipp H . [Foot injuries in the polytraumatized patient]. Unfallchirurg. 2005; 108(10):858-65. DOI: 10.1007/s00113-005-0993-1. View

19.

Jansen H, Frey S, Ziegler C, Meffert R, Doht S . Results of dynamic pedobarography following surgically treated intra-articular calcaneal fractures. Arch Orthop Trauma Surg. 2012; 133(2):259-65. DOI: 10.1007/s00402-012-1655-8. View

20.

Pozo J, KIRWAN E, Jackson A . The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg Br. 1984; 66(3):386-90. DOI: 10.1302/0301-620X.66B3.6725350. View