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Effects of custom-made insole on gait pattern of patients with unilateral displaced intra-articular calcaneal fracture: evaluation with computerized gait analysis.
Oçgüder A, Gök H, Heycan C, Tecimel O, Tönük E, Bozkurt M. Acta Orthop Traumatol Turc. 2012;46(1):1-7.
Quote:
OBJECTIVE:
The aim of this study was to investigate whether use of custom-fabricated insoles improves the gait pattern in patients with displaced intra-articular calcaneal fractures.
METHODS:
Fourteen patients (7 female, 7 male; mean age: 39±12 years) and 11 healthy individuals (mean age: 42±13 years) were included in the study. Treatment protocol included conservative treatment involving immobilization, with or without closed reduction, active exercises, wear of a custom-fabricated insole and prospective follow-up. All patients were evaluated by physical examination, axial and lateral radiographs, computerized tomography, and computerized gait analysis.
RESULTS:
The use of custom-made insoles significantly improved step and stride lengths and the peak values of fore-aft component in the involved foot and tended to increase plantarflexor moment and total ankle power. The majority of patients (71%) continued to have substantial mechanical abnormalities by computerized gait analysis. Plantar flexion moment, total ankle power, vertical component of ground reaction forces (GRFs), and total sagittal plane excursion were significantly decreased in the involved foot when compared to the uninvolved foot. Plantar flexion moment, total ankle power, vertical, fore-aft and mediolateral componentsof GRFs were significantly decreased in the involved foot when compared to the healthy control group.
CONCLUSION:
Use of a custom-made insole improves advancement of limb and weight-bearing in patients with a displaced intra-articular calcaneal fracture. Nevertheless, mechanical abnormalities persist in the affected limb, which does not appear to recover a gait pattern similar to that of normal walking.
Re: Custom foot orthotics following treatment of calcaneal fracture
I have treated many patients post calcaneal fracture. There is a trick to their care. After the final cast is removed, and the patient returns to weight bearing, there is invariably swelling on the affected side. I start with a type of temporary orthotic, and follow every 3 weeks. I will often change or at least reheat and remold the temporary device at each visit BECAUSE IT IS TOO LARGE! As the swelling decreases, temps are changed (or remolded) until their is no visible physical change over a 3-6 week period. Making custom devices once this "end of residual swelling" point is reached provides for excellent long term outcomes.
Re: Custom foot orthotics following treatment of calcaneal fracture
Quote:
Originally Posted by Dananberg
I have treated many patients post calcaneal fracture. There is a trick to their care. After the final cast is removed, and the patient returns to weight bearing, there is invariably swelling on the affected side. I start with a type of temporary orthotic, and follow every 3 weeks. I will often change or at least reheat and remold the temporary device at each visit BECAUSE IT IS TOO LARGE! As the swelling decreases, temps are changed (or remolded) until their is no visible physical change over a 3-6 week period. Making custom devices once this "end of residual swelling" point is reached provides for excellent long term outcomes.
Howard
I agree with Howard. It is also important to check the range, direction and quality of motion of the stj. Due to the tendency for pronatory spasm of the foot, we have often used orthoses post calcaneal fracture to apply a supination moment to the rearfoot in order to increase the stj supination rom. Obviously at lot depends on the nature and severity of the fracture. Sometimes it is necessary to use a pronated cast and use serial casting and orthoses to progressively restore supination rom, when possible (per Merton Root, who did not always advocate neutral position casting or neutral position orthoses as some believe).
Re: Custom foot orthotics following treatment of calcaneal fracture
Quote:
The use of custom-made insoles significantly improved step and stride lengths and the peak values of fore-aft component in the involved foot and tended to increase plantarflexor moment and total ankle power.
I've long wanted to see this measure pre and post orthosis in other pathologies. I've theorized that you would see increased ankle power with orthotic use.
It's remarkable that post calcaneal fracture that you can see improvement with orthosis. When I first read the abstract, and saw displaced intracalcaneal fractures. However, some of those could not involve the joint. If the fractures did involve the posterior facet, or the posterior facet "sunk" into the rest of the calcaneus, then I would think that orthotics would be less effective, because the STJ would probably have no motion and hurt just to bear weight. I wonder if the paper classified the fractures.
Re: Custom foot orthotics following treatment of calcaneal fracture
Quote:
Originally Posted by efuller
I've long wanted to see this measure pre and post orthosis in other pathologies. I've theorized that you would see increased ankle power with orthotic use.
It's remarkable that post calcaneal fracture that you can see improvement with orthosis. When I first read the abstract, and saw displaced intracalcaneal fractures. However, some of those could not involve the joint. If the fractures did involve the posterior facet, or the posterior facet "sunk" into the rest of the calcaneus, then I would think that orthotics would be less effective, because the STJ would probably have no motion and hurt just to bear weight. I wonder if the paper classified the fractures.
Custom foot orthotics following treatment of calcaneal fracture
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