Clinical and gait analysis of 171 unilateral calcaneal fractures

INTRODUCTION:: Reviewing the management of calcaneus fractures, conservative and operative treatment are known without a generally accepted, well proven therapeutical strategy or tactics compared to other types of fractures. The purpose of this study is to define the parameters of the differences between the fractured calcaneus and the intact one, as well as the two types of treatments using the gait analysis method. MATERIALS AND METHODS:: Retrospective clinical investigation and gait analysis have been performed on 217 patients with calcaneus fractures. An analysis of the X-rays was also included. The Novel 101 B pedobarography analyser with platform 102H (4 sensor/cm(2)) was used for pressure distribution analysis. The region of the foot was divided into four masks, Mask 1 (M1) the area of the heel, Mask 2 (M2), the mid-foot, Mask 3 (M3), metatarsal region, and Mask 4 (M4) the region of the toes. The total area of the foot (TOT) included all four masks. Eighteen bilateral fractured calcanei have been omitted from the evaluation, owing to the lack of control foot, and 28 patients were excluded for the other complications of the fractures foot, complications of the control foot or complications extending to both feet. The data on the 171 fractures (68 patients treated conservatively and 103 patients treated operatively) of the calcaneus were compared with their control feet. The average age was 52.0 years (+/- 2.7) and the average follow up time was 49.9 months (+/- 17.5). The statistical analysis was performed using SPSS for Windows. Examination of correlation, repeated measurement analysis of variance, ANOVA, and multiple comparisons were performed by Bonferoni. Linear discriminating analysis was also performed. Significance level was defined as p<0.05 in each case. RESULTS:: All investigated parameters (area, max.F, max.P, absolute and relative contact time, FTI, PTI.) of M2 were significantly higher on the fractured side than on the intact one. The investigation of the whole foot showed significant increase concerning the area, and significant decrease in the max. force, FTI and PTI values. The differences between the conservatively treated and the intact foot values, as well as the differences between operatively treated foot and the intact one, demonstrated a significant decrease in the FTI TOT and the PTI TOT in both groups. A significantly higher difference was also demonstrated when the difference in the value of PTI TOT in the operative group was compared to the conservative one. Therefore, the values of the fractured side of the operative group were significantly lower than the values of the intact one, but significantly higher than the values of the conservative group. CONCLUSIONS:: The gait analysis parameters for the calcaneus fractured and the intact sides allowed for separation of the data according to significant differences. The results of the gait analysis comparing the conservative and operative method of the treatment showed that the surgical method was the better choice.