Gait Alterations in Adults after Ankle Fracture: A Systematic Review.

Marta Mirando,Federica Zeni,Corrado Conti,Antonio Nardone,Fabio Pedicini,Chiara Pavese

doi:10.3390/diagnostics12010199

Abstract

(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.

Highlights

The anatomical definition of ankle refers to the joint formed by the tibia, fibula, and talus, which is physiologically stabilized by the action of neighbor muscles and ligaments
The literature search identified a total of 1120 studies: 465 from PubMed, 653 from Embase, and 2 from PEDro
We found only four studies that evaluated the effect of prescription footwear and orthoses after ankle fracture using instrumental methods of gait assessment

Summary

Introduction

The anatomical definition of ankle refers to the joint formed by the tibia, fibula, and talus, which is physiologically stabilized by the action of neighbor muscles and ligaments. Most of the surgical and functional classifications of ankle fractures include lesions of tibial and/or fibular malleolus and the neighboring ligamentous structures, but not talus fractures, which are usually classified as foot injuries. The three most used ankle fracture classifications are that of Danis–Weber, based on the level of the fibula fracture, that of Lauge-Hansen, focused on the mechanism of injury, and the Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopedic Trauma Association (AO/OTA) classification, based on the location of the fracture lines and the degree of comminution [1]. Malleoli are the structures most frequently involved: about 60–70% of ankle fractures are unimalleolar (mainly affecting the lateral malleolus), followed by bimalleolar (15–20%) and trimalleolar fractures (7–12%) [4]. Males are more predominant in the younger age groups, females more predominant in the older age groups [9]

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Results

Discussion

Conclusion