International Orthopaedics

Long-term pathological gait pattern changes after talus fractures — dynamic measurements with a new insole

Benedikt J. Braun, Jörg H. Holstein, Patrick Pelz, Nils T. Veith, Tim Pohlemann, Mika Rollmann, Moritz Klein, Steven C.Herath

Department ofTrauma, Hand and Reconstructive Surgery, Saarland University Hospital


Talus, Fracture, Gait analysis, Pedobarography


Purpose The aim of the current study was to describe long-term gait changes after talus fractures, identify patterns associated with poor outcome and discuss possible treatment options based on dynamic gait analysis. Methods Twenty-seven patients were followed-up clinically and via gait analysis after talus fracture osteosynthesis. Continuous dynamic pedobarography with a gait analysis insole was performed on a standardized parcours consisting of different gait tasks and matched to the outcome. Results Mean follow-up was 78.3 months (range 21–150), mean AOFAS and Olerud-Molander scores 66 (range 20–100) and 54 (range 15–100). Significant correlations between fracture classification and osteoarthritis (Hawkins: rs = 0.67 / Marti-Weber: rs = 0.5) as well as several gait differences between injured and healthy foot with correlations to outcome were seen: decreased step load-integral/maximum-load; associations between centre-of-pressure displacement and outcome as well as between temporospatial measures and outcome. Overall, pressure-distribution was lateralized in patients with subtalar joint injury (Δ: 0.5765 N/cm2, p = 0.0475). Conclusions Talus fractures lead to chronic gait changes and restricted function. Dynamic pedobarography can identify patterns associated with poor results. The observed gait patterns suggest that changes can be addressed by physical therapy and customized orthoses to improve overall outcome. The presented insole and measurement protocol are immediately feasible as a diagnostic and rehabilitation aid.

Moticon's Summary

Talus fractures, constituting a mere 0.3% of all fractures, pose significant clinical challenges due to high complication rates like avascular necrosis and osteoarthritis. This retrospective observational study analyzed gait changes in 27 patients with operatively treated talar fractures between 2002 and 2014 using dynamic pedobarography. Gait analysis was conducted using Moticon sensor insoles. The study aimed to correlate gait alterations with fracture severity, radiographic outcomes, and clinical results. Significant differences were observed between the injured and uninjured extremities, particularly in step-load-integral and maximum-load reductions. Mediolateral center-of-pressure (COP) excursions were altered, especially during stair-related tasks. These gait changes were linked to functional impairments and residual pain. The study concluded that task-specific dynamic gait analysis could identify pathological gait patterns and inform therapeutic interventions. The authors suggested further research into pedobarographic-assisted physical therapy to improve clinical outcomes.

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