Pedobarography and motion analysis for the patients after operative fixation of calcaneal fracture

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Pedobarography and motion analysis for the patients after operative fixation of calcaneal fracture


Author: Tsui, Hon-for
Title: Pedobarography and motion analysis for the patients after operative fixation of calcaneal fracture
Degree: M.Sc.
Year: 2001
Subject: Heel bone -- Fractures
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Jockey Club Rehabilitation Engineering Centre
Pages: xvi, 90 leaves : ill. (some col.) ; 30 cm
Language: English
InnoPac Record:
Abstract: Calcaneal fracture is the most common fracture of the hindfoot since human assumed the erect posture and began to defy gravity. The fracture occurs after falling from height and landing on the heel. It is usually intra-articular fracture involving the subtalar joint. Operation with anatomical reduction and internal fixation aiming to restore the joint congruity is the advocated treatment and better functional result is obtained with this treatment method. However, this treatment procedure does not guarantee a complete return of the normal function of the patient. Although many patients do not have difficult in activity of daily living, some of them still complain of residual pain over hindfoot or heel area. Most of them have restriction of the walking ability with decrease of the walking time or distance. The difficulty in walking occurs on the uneven or sloped ground. It is a disabling complication since walking on this condition is very common in daily life. Twelve normal controls and fifteen patients with unilateral fracture of the calcaneal were involved in this study. The patients had similar pattern of fracture, same treatment method and rehabilitation program. Gait analysis was performed on the normal and patient groups. Assessment of the patients group including clinical score, dynamic plantar pressure evaluation and motion analysis of the ankle and subtalar joint were performed on the level ground and side sloped walking conditions. For the normal control group, no significant difference on dynamic plantar pressure was found during either level ground or side slope walking. However, in the patient group, there was a statistical significant difference of the plantar pressure found between the injured and normal foot. It was particular obvious during walking on the slide sloped walkway, and when the injured foot was positioned on the high side of the slope. There was a reduced plantar pressure under hindfoot area and increased plantar pressure under midfoor and fifth metatarsal area. Abnormal pattern of the plantar pressure loading was also observed in some of the patients. There was a consistent pattern found from the angle-angle diagram of the ankle and subtalar joint in normal subjects and the normal foot of the patients but this rhythm was lost in the injured foot. The pattern change of the angle-angle plot on the injury side was presented with a reduction of the range of the ankle and subtalar joint during the loading phase of the walking cycle. This finding provided a simple graphic method for surgeons to evaluate the treatment outcome. The complication of the calcaneal fracture was loss of congruity of the subtalar joint that is the main component of the inversion and evasion of the foot. Since eversion will increase the pressure of the subtalar joint, the abnormality of the plantar pressure and subtalar motion can be explained by the decrease of the eversion of the subtalar joint during the loading phase of the walking cycle. By performing pedobarographic and motion analysis during dynamic walking, patients with poor recovery can be easily identified. Further investigation with special focus on this group should be conducted to investigate the cause and treatment of this residual complication.

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