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Published in: International Orthopaedics 5/2018

01-05-2018 | Original Paper

Long-term pathological gait pattern changes after talus fractures — dynamic measurements with a new insole

Authors: Benedikt J. Braun, Patrick Pelz, Nils T. Veith, Mika Rollmann, Moritz Klein, Steven C. Herath, Jörg H. Holstein, Tim Pohlemann

Published in: International Orthopaedics | Issue 5/2018

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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: rs = 0.67 / Marti-Weber: rs = 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/cm2, 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.
Literature
1.
3.
go back to reference Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, Falaise V, Pineau V, Salle de Chou E, Noailles T, Carvalhana G, Ruhlmann F, Huten D (2012) Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res 98(4 Suppl):S48–S55. https://doi.org/10.1016/j.otsr.2012.04.012 CrossRefPubMed Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, Falaise V, Pineau V, Salle de Chou E, Noailles T, Carvalhana G, Ruhlmann F, Huten D (2012) Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res 98(4 Suppl):S48–S55. https://​doi.​org/​10.​1016/​j.​otsr.​2012.​04.​012 CrossRefPubMed
5.
go back to reference Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD (2004) Functional outcomes following displaced talar neck fractures. J Orthop Trauma 18(5):265–270CrossRefPubMed Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD (2004) Functional outcomes following displaced talar neck fractures. J Orthop Trauma 18(5):265–270CrossRefPubMed
8.
11.
14.
go back to reference Canale ST, Kelly FB Jr (1978) Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 60(2):143–156CrossRefPubMed Canale ST, Kelly FB Jr (1978) Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 60(2):143–156CrossRefPubMed
16.
go back to reference Olerud C, Molander H (1984) A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 103(3):190–194CrossRefPubMed Olerud C, Molander H (1984) A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 103(3):190–194CrossRefPubMed
18.
go back to reference Rammelt S, Biewener A, Grass R, Zwipp H (2005) Foot injuries in the polytraumatized patient. Unfallchirurg 108(10):858–865CrossRefPubMed Rammelt S, Biewener A, Grass R, Zwipp H (2005) Foot injuries in the polytraumatized patient. Unfallchirurg 108(10):858–865CrossRefPubMed
19.
go back to reference Metzger MJ, Levin JS, Clancy JT (1999) Talar neck fractures and rates of avascular necrosis. J Foot Ankle Surg 38(2):154–162CrossRefPubMed Metzger MJ, Levin JS, Clancy JT (1999) Talar neck fractures and rates of avascular necrosis. J Foot Ankle Surg 38(2):154–162CrossRefPubMed
20.
go back to reference Pajenda G, Vecsei V, Reddy B, Heinz T (2000) Treatment of talar neck fractures: clinical results of 50 patients. J Foot Ankle Surg 39(6):365–375CrossRefPubMed Pajenda G, Vecsei V, Reddy B, Heinz T (2000) Treatment of talar neck fractures: clinical results of 50 patients. J Foot Ankle Surg 39(6):365–375CrossRefPubMed
23.
go back to reference Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR (2011) Cross-sectional analysis of foot function, functional ability, and health-related quality of life in older people with disabling foot pain. Arthritis care & research 63(11):1592–1598. https://doi.org/10.1002/acr.20578 CrossRef Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR (2011) Cross-sectional analysis of foot function, functional ability, and health-related quality of life in older people with disabling foot pain. Arthritis care & research 63(11):1592–1598. https://​doi.​org/​10.​1002/​acr.​20578 CrossRef
24.
go back to reference Baratto L, Morasso PG, Re C, Spada G (2002) A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques. Mot Control 6(3):246–270CrossRef Baratto L, Morasso PG, Re C, Spada G (2002) A new look at posturographic analysis in the clinical context: sway-density versus other parameterization techniques. Mot Control 6(3):246–270CrossRef
25.
go back to reference Hesse S, Luecke D, Jahnke MT, Mauritz KH (1996) Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. Int J Rehabil Res 19(2):133–141CrossRefPubMed Hesse S, Luecke D, Jahnke MT, Mauritz KH (1996) Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis. Int J Rehabil Res 19(2):133–141CrossRefPubMed
29.
go back to reference Rosenbaum D, Lubke B, Bauer G, Claes L (1995) Long-term effects of hindfoot fractures evaluated by means of plantar pressure analyses. Clin Biomech 10(7):345–351CrossRef Rosenbaum D, Lubke B, Bauer G, Claes L (1995) Long-term effects of hindfoot fractures evaluated by means of plantar pressure analyses. Clin Biomech 10(7):345–351CrossRef
30.
go back to reference Pozo JL, Kirwan EO, Jackson AM (1984) The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg Br Vol 66(3):386–390CrossRef Pozo JL, Kirwan EO, Jackson AM (1984) The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg Br Vol 66(3):386–390CrossRef
32.
go back to reference Spaulding SJ (2008) Basic biomechanics. In: Jacobs K (ed) Ergonomics for therapists. Elsevier, St. Louis, p 460 Spaulding SJ (2008) Basic biomechanics. In: Jacobs K (ed) Ergonomics for therapists. Elsevier, St. Louis, p 460
33.
go back to reference Winstein CJ, Pohl PS, Cardinale C, Green A, Scholtz L, Waters CS (1996) Learning a partial-weight-bearing skill: effectiveness of two forms of feedback. Phys Ther 76(9):985–993CrossRefPubMed Winstein CJ, Pohl PS, Cardinale C, Green A, Scholtz L, Waters CS (1996) Learning a partial-weight-bearing skill: effectiveness of two forms of feedback. Phys Ther 76(9):985–993CrossRefPubMed
Metadata
Title
Long-term pathological gait pattern changes after talus fractures — dynamic measurements with a new insole
Authors
Benedikt J. Braun
Patrick Pelz
Nils T. Veith
Mika Rollmann
Moritz Klein
Steven C. Herath
Jörg H. Holstein
Tim Pohlemann
Publication date
01-05-2018
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 5/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3720-y

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