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 plantarflexor 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 componentsof 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.