Long-term effects of hindfoot fractures evaluated by means of plantar pressure analyses.

The present study investigated the long-term effects of calcaneal fractures on the plantar pressure distribution during human gait. Fourteen patients participated in a follow-up study and were assigned to a group with good or poor calceneus restoration as indicated by normal or reduced Böhler's angle. Ten normal subjects with similar anthropometric characteristics were used for comparison. Gait analysis was performed by means of a capacitive pressure distribution platform. A comparison of the injured with the healthy foot of all patients revealed a statistically significant peak pressure decrease under medial areas of the foot (first metatarsal -24%) and an increase in lateral areas (midfoot +135%, fifth metatarsal +122%). This load shift towards a lateral loading indicates a persisting deviation of the gait pattern long after healing. Furthermore we investigated whether the success of the restoration of hindfoot geometry as reflected in Böhler's angle had an effect on the foot loading characteristics. Therefore we compared the gait patterns of the two patient groups with the normal subjects. However, the results did not reveal more abnormal pressure patterns in the poorly reduced group. RELEVANCE:--The restoration of the shape of the calcaneus with joint surface congruity and reconstruction of Böhler's angle appears generally accepted as a major aim in the treatment of calcaneal fractures. While this goal can usually be achieved by contemporary surgical techniques, the restoration of foot function under dynamic loading conditions is not guaranteed and should be assessed objectively. The investigation of the foot loading characteristics by means of plantar pressure measurements can be used to support the evaluation of the patient's recovery after trauma.