The effects of intraarticular calcaneal fractures on static anddynamic plantar pressures

Introduction: Today, with the increase in industrialization, the frequency of calcaneal fractures is increasing. Since calcaneal fractures are more common in young adults and middle ages, they can have important economic effects. In this single-center study, we aimed to examine the effects of the fracture on static and dynamic plantar pressures by pedobarographic measurements in the post-healing period of patients who had an intra-articular calcaneal fracture. Materials and method: In our clinic, 35 cases (26 men, 9 women) who were treated for intra-articular calcaneal fractures between 2013 and 2020, at least 12 months after the fracture and followed up, were evaluated. While the mean age at the time of surgery was 49.4±12.3 for men, it was 47.3±10.9 for women. Demographic data of these patients, direct radiography and CT imaging findings related to trauma, control examination findings performed within the scope of the study, and static and dynamic plantar pressure parameters measured by pedobarography device were recorded. 57 parameters including demographic, radiological, clinical and pedobarographic measurement data of the patients were evaluated. Statistical evaluations were made with the rule of (p<0,05). Results: Böhler and Gissane angles were measured in the last post-treatment radiographs of all fractures included in the study. The normal reference value of the Böhler angle was taken as 20-40 degrees, and its relationship with AOFAS, SF-36 parameters and VAS scores was evaluated. There was a significant difference in emotional role difficulty and pain sub-parameters (p<0,05). Similarly, a statistically significant difference was observed in patients with normal Böhler angle in terms of increasing AOFAS score and decreasing VAS score (p<0,05). The static and dynamic plantar pressure parameters and gait distance-time parameters of the patients were examined. Maximum pressure (p:0,012), percent forefoot pressure (p:0,00) and forefoot pressure area (p:0,013) between the injured and uninjured feet vii of the patients who underwent surgery. There was a statistically significant difference in the direction of increase in the uninjured side. When we look at the conservatively treated group, weight (p:0,041), weight percentage (p:0,041), contact area (p:0,050), contact area percentage between the injured and uninjured foot (p:0,050), midfoot contact area (p:0,034), mean double stride length (p:0,05) parameters, there was a significant difference in the direction of increase on the uninjured foot, and in the direction of increase in the percentage of hindfoot pressure (p:0,005) parameter on the injured foot found. Percentage changes of static, dynamic and gait distance-time parameters between injured and uninjured feet were calculated and the results were compared by grouping the patients treated conservatively with surgery. Maximum pressure (p:0,022), percent forefoot weight (p:0,00), anterior foot there was a statistically significant difference in the direction of increase in foot pressure area (p:0,007) and cadence (p:0,024) parameters in those treated conservatively. The percentage of hindfoot weight (p:0,009) and forefoot width (p:0,048) increased in those treated surgically, a statistically significant difference was found. Conclusion: The AOFAS, VAS and SF-36 scores of calcaneal fractures, whose Böhler angles were measured between the reference values, were better. The same relationship was not found for the Gissane angles. In our study, the most common pathology detected in the physical examination after fracture healing was pes planus. In the surgically treated group, the most common symptom was the sural nerve related symptoms. It was found that intraarticular calcaneal fractures changed the static and dynamic plantar pressure distributions of the foot. However, with the extended lateral approach it was considered that there was no significant difference between surgically treated patients and conservatively treated patients in terms of plantar pressure changes.