Vertical ground reaction forces in patients after calcaneal trauma surgery

Introduction: Vertical ground reaction forces (VGRFs) are altered in patients after foot trauma. It is not known if this correlates with ankle kinematics. The aim of this study was to analyze VGRFs in patients after calcaneal trauma and correlate them to patient-reported outcome measures (PROMs), radiographic findings and kinematic analysis, using a multi-segment foot model. In addition, we determined the predictive value of VGRFs to identify patients with altered foot kinematics.

Methods: Thirteen patients (13 feet) with displaced intra-articular calcaneal fractures, were included an average of two years after trauma surgery. PROMs, radiographic findings on postoperative computed tomography scans, gait analysis using the Oxford foot model and VGRFs were analysed during gait. Results were compared with those of 11 healthy subjects (20 feet). Speed was equal in both groups, with healthy subjects walking at self-selected slow speed (0.94 +/- 0.18m/s) and patients after surgery walking at self-selected normal speed (0.94 +/- 0.29 m/s). ROC curves were used to determine the predictive value.

Results: Patients after calcaneal surgery showed a lower minimum force during midstance (p = 0.004) and a lower maximum force during toe-off (p = 0.011). This parameter correlated significantly with the range of motion in the sagittal plane during the push-off phase (r 0.523, p = 0.002), as well as with PROMs and with postoperative residual step-off (r 0.423, p = 0.016). Combining these two parameters yielded a cut-off value of 193% (p <0.001), area under the curve 0.93 (95% confidence interval 0.84-1.00).

Conclusion: Patients after calcaneal fracture showed lower minimum force during midstance and lower maximum force during toe-off compared to healthy subjects. This lower maximum force during push-off correlated significantly with PROMs, range of motion in the sagittal plane during push-off and radiographic postoperative residual step-off in the posterior facet of the calcaneal bone. VGRFs are a valuable screening tool for identifying patients with altered gait patterns.