Persistent functional deficits after ankle fracture surgery: A long-term gait and functional analysis

Ankle fractures are among the most common lower limb fractures, particularly in individuals over 50 years of age. Despite surgical interventions, long-term functional impairments, such as joint stiffness and gait abnormalities, may persist. This study aimed to evaluate long-term gait and functional outcomes following ankle fracture surgery.

To investigate spatiotemporal gait parameters, heel-rise performance, and ankle dorsiflexion mobility in individuals who underwent surgical treatment for ankle fractures.

A cross-sectional observational study.

Fourteen participants (mean age 53.7 years) were evaluated at a mean follow-up of 4.5 years post-surgery. Spatiotemporal gait parameters were assessed using the GAITRite® system. Functional performance was examined with the Heel Rise Test and Weight-Bearing Lunge Test (WBLT), along with validated clinical scales, including the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and the Olerud-Molander Ankle Score (OMAS). Intrarater reliability of the functional tests was determined using intraclass correlation coefficients (ICCs).

Step length was significantly greater on the surgical side (p = 0.016), while double support time was reduced (p = 0.043). The Heel Rise Test (p = 0.020) and WBLT (p = 0.006) demonstrated significant deficits on the surgical side compared to the non-surgical side. Despite high AOFAS (86.5) and OMAS (80) scores, functional limitations persisted. Reliability analysis showed excellent intrarater consistency for the Heel Rise Test (ICC = 0.98) and WBLT (ICC = 0.99), with low SEM and MDC values.

Long-term functional deficits, particularly in ankle dorsiflexion and plantarflexion strength, persist despite seemingly favorable clinical scores. These findings underscore the need for targeted rehabilitation strategies to improve soft tissue mobility and muscle function after ankle fracture surgery.

Level III.