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Foot Function After Surgically Treated Intraarticular Calcaneal Fractures

Correlation of Clinical and Pedobarographic Results of 65 Patients Followed for 8 Years

Dürr, Constanze, MD*; Apinun, Jirun, MD; Mittlmeier, Thomas, MD, PhD; Rammelt, Stefan, MD, PhD*

doi: 10.1097/BOT.0000000000001325
Original Article

Objectives: To correlate functional deficits after surgical treatment of displaced intraarticular calcaneal fractures (DIACFs) as measured through dynamic pedobarography with clinical and radiographic long-term results.

Design: Retrospective single-center study.

Setting: Level 1 trauma center.

Patients: Sixty-five patients with unilateral DIACFs, reexamined at an average of 8.1 years after surgery.

Intervention: Internal fixation of DIACF with lateral plate or percutaneous screws.

Main Outcome Measurements: Dynamic pedobarography, AOFAS, Zwipp, SF-36 scores, Foot Function Index, Böhler angle, and articular congruity.

Results: When compared with the uninjured side, pedobarography of the operated foot revealed a significantly increased contact area of the hindfoot and midfoot, with a decreased contact area under first/second metatarsal (MT) and first/second toe after DIACF. Maximum pressure and pressure time integral were significantly increased at the midfoot and lateral MT with a decrease under the hindfoot and first to second MT/toe. Midfoot pressure time integral correlated with the range of plantarflexion. Fracture classification correlated with MT 1 contact time. Hindfoot and MT contact times were negatively correlated with Böhler angle. Patients with the smallest side-to-side differences in pedobarogaphy had overall highest scores and significantly greater ankle/hindfoot range of motion at follow-up.

Conclusions: Significant correlations were found between clinical and pedobarographic results. Increased contact areas and time at the midfoot indicating a lateral load shift correlated with inferior outcome and decreased subtalar motion. These results support the importance of reconstruction of the subtalar joint and overall bony morphology of the calcaneus with preservation of subtalar motion as necessary for global foot function.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

*University Center for Orthopaedics and Traumatology, University Hospital Dresden Carl Gustav Carus, Dresden, Germany;

Department of Orthopedics, King Chulalongkorn Memorial Hospital Bangkok, Bangkok, Thailand; and

Surgical Center, Rostock University Medical Center, Rostock, Germany.

Reprints: Stefan Rammelt, MD, PhD, University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany (e-mail:

Supported by Thomas Zerjatke, Dipl. Biomath., of the Institute for Medical Informatics and Biometry (IMB), Dresden, Germany.

The authors report no conflict of interest.

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Accepted August 14, 2018

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