What is the added value of pedobarography for assessing functional outcome of displaced intra-articular calcaneal fractures? A systematic review of existing literature. (February 2020)

• Record Type: Journal Article
• Authors: Sanders, Fay R.K.; Peters, Jess J.; Schallig, Wouter; Mittlmeier, Thomas; Schepers, Tim
• Is Part Of: Clinical biomechanics. Volume 72(2020)
• Page Start: 8
• Page End: 15
• Publication Date: 2020-02
• Subjects: Intra-articular calcaneal fractures -- Pedobarography -- Plantar pressure -- Functional outcome; Biomechanics -- Periodicals; Osteopathic medicine -- Periodicals; Biomechanics -- Periodicals; Osteopathic Medicine -- Periodicals; 612.76
• DOI: 10.1016/j.clinbiomech.2019.11.013
• Languages: English
• ISSNs: 0268-0033

Abstract

Abstract: Background: Displaced intra-articular calcaneal fractures often result in permanent disability, reduced quality of life and high socio-economic costs. Since they often result in a change in geometry of the foot, pedobarography may be useful in predicting outcome at an early stage. The aim of this study was to examine whether a correlation exists between pedobarography and functional outcomes in patients with a displaced intra-articular fracture. Methods: In this systematic review, studies were included when they investigated the correlation between pedobarography and functional outcome in displaced intra-articular calcaneal fractures. Excluded were studies on <10 patients or on animals/cadavers. Collected were baseline patient/treatment characteristics, pedobarographic data (peak pressures, maximum force and centre of pressure) and functional outcome scores. Findings: Out of 153 abstracts, 40 remained for full text screening and 9 were included. Pedobarographic measurements (pressure plate or insoles) showed a lateralization of centre of pressure, decreased pressures underneath the hindfoot, first and second toe and increased pressure underneath the midfoot and forefoot. Correlations with functional outcome were found in some combined pedobarographic results (entire foot/multiple measurements), but hardly in pressures underneath specific foot areas. Interpretation: Even though increased or decreased pressures in specific areas of the foot may not be directly related to functional outcome, combined scores often did. For pedobarography to serve as a prediction tool, it should be more standardised. However, assessing centre of pressure and altered peak pressures underneath the foot, may be useful in developing customized aids such as insoles, aiming for a more individualized improvement. Highlights: The pressure distribution after an intra articular calcaneal fracture differs from the other foot. In displaced intra-articular calcaneal fractures the centre of pressure shifts to lateral. Functional outcome is only correlated with combined pedobarographic measurements. Pedobarography is best used for individualized improvement through customized aids.