Effects of custom-made insole on gait pattern of patients with unilateral displaced intra-articular calcaneal fracture: evaluation with computerized gait analysis.

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 plantar flexor 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 components of 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.

Functional evaluation of intraarticular severely comminuted fractures of the calcaneus with gait analysis.

Twenty-one patients (23 feet) treated nonsurgically for severely comminuted intraarticular fractures of the calcaneus were evaluated prospectively with a clinical scoring scale and computerized gait analysis. All patients had Sanders type III and type IV fractures. The treatment protocol consisted of no closed reduction, immobilization in removable splint, physiotherapy after edema subsided, and weightbearing after 8 weeks. All patients had a minimum follow-up of 2 years (mean, 38 months). Clinical results were good in 2 patients, fair in 3 patients, and poor in 16 patients. Gait analysis showed that patients were at high risk of gastrocnemius weakness and ankle and knee instability. These results may be useful for comparison with the results of other methods, such as open reduction and internal fixation, nonsurgical closed reduction, and arthrodesis.

Comparison of landing maneuvers between male and female college volleyball players.

OBJECTIVE: To compare differences in kinematic and kinetic parameters of knee, hip and ankle joints between male and female college volleyball players. DESIGN: Cross-sectional study. BACKGROUND: Landing injuries, which usually involve anterior cruciate ligament injuries, are common in volleyball with a higher incidence in females. Landing preferences of both male and female players may provide additional background about the mechanisms contributing to the anterior cruciate ligament injuries. METHODS: Eight female and eight male college volleyball players performed spike and block landings from 40 and 60 cm height platforms. Lower extremity joint kinetics and kinematics, and leg muscle strengths were recorded. RESULTS: Females demonstrated significantly lower knee and hip flexion angles compared to their male counterparts in knee flexion at 40 cm spike and hip flexion at 40 cm block landings. Group comparison also revealed that male players' peak knee extensor moment at 60 cm block landing was significantly different than female players. Additionally, female players applied significantly higher normalized ground reaction forces and males knee flexion angles and thigh muscle strength results positive and highly correlated but relation could not found in females. It is likely that females may not use their thigh muscles as effective as males in landing. CONCLUSION: Female volleyball players initiate different lower extremity mechanics during landings than that of males. RELEVANCE: Identifying the landing strategy differences between female and male college volleyball players may provide detailed perspective about the load distribution in lower extremity joints for determining major factors affecting the increased incidence of anterior cruciate ligament injuries in females.