Abstract
Fractures of the calcaneus are often associated with serious permanent disability,
a considerable reduction in quality of life, and high socio-economic cost. Although
some studies have already reported changes in plantar pressure distribution after
calcaneal fracture, no investigation has yet focused on the patient‘s strength and
postural control.
Method
60 patients with unilateral, operatively treated, intra-articular calcaneal fractures
were clinically and biomechanically evaluated >1 year postoperatively (physical examination,
SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis
including plantar pressure distribution). Results were correlated to clinical outcome
and preoperative radiological findings (Böhler angle, Zwipp and Sanders Score).
Results
Clinical examination revealed a statistically significant reduction in range of motion
at the tibiotalar and the subtalar joint on the affected side. Additionally, there
was a statistically significant reduction of plantar flexor peak torque of the injured
compared to the uninjured limb (p < 0.001) as well as a reduction in postural control that was also more pronounced on
the initially injured side (standing duration 4.2 ± 2.9 s vs. 7.6 ± 2.1 s, p < 0.05). Plantar pressure measurements revealed a statistically significant pressure
reduction at the hindfoot (p = 0.0007) and a pressure increase at the midfoot (p = 0.0001) and beneath the lateral forefoot (p = 0.037) of the injured foot.
There was only a weak correlation between radiological classifications and clinical
outcome but a moderate correlation between strength differences and the clinical questionnaires
(CC 0.27–0.4) as well as between standing duration and the clinical questionnaires.
Although thigh circumference was also reduced on the injured side, there was no important
relationship between changes in lower leg circumference and strength suggesting that
measurement of leg circumference may not be a valid assessment of maximum strength
deficits. Self-selected walking speed was the parameter that showed the best correlation
with clinical outcome (AOFAS score).
Conclusion
Calcaneal fractures are associated with a significant reduction in ankle joint ROM,
plantar flexion strength and postural control. These impairments seem to be highly
relevant to the patients. Restoration of muscular strength and proprioception should
therefore be aggressively addressed in the rehabilitation process after these fractures.
Keywords
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Article info
Publication history
Accepted:
September 30,
2010
Identification
Copyright
© 2010 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
