Warwick Orthopaedics, Division of Health Sciences, Warwick Medical School, Clinical Sciences Research Laboratories, University Hospital, Coventry, United Kingdom.
Am J Sports Med. 2011 Dec;39(12):2679-85. doi: 10.1177/0363546511420809. Epub 2011 Sep 9.
Advances in the management of Achilles tendon rupture have led to the development of immediate weightbearing protocols. These vary regarding which ankle-foot orthoses (AFOs) are used and the number of inserted heel wedges used within them.
This study was conducted to evaluate plantar pressure measurements and temporal gait parameters within different AFOs, using different numbers of heel wedges.
Controlled laboratory study.
Fifteen healthy participants were evaluated using 3 different AFOs, with 4 different levels of inserted heel wedges. Therefore, a total of 12 conditions were evaluated, in a sequence that was randomly allocated to each participant. Pressure and temporal gait parameters were measured using an in-shoe F-Scan pressure system, and range of movement was measured using an electrogoniometer.
Ankle-foot orthoses that were restrictive in design, combined with a higher number of inserted heel wedges, reduced forefoot pressures, increased heel pressures, and decreased the amount of time spent in the terminal stance and preswing phase of the gait cycle (P = .029, .002, and .001).
The choice of AFO design and the number of inserted heel wedges have a significant effect on plantar pressure measurements and temporal gait parameters. The implications of these changes need to be applied to the clinical management of acute Achilles tendon ruptures. This clinical management requires a balance between protected weightbearing and functional loading, requiring further research within a clinical context.
The biomechanical data from this research imply that a carbon-fiber AFO, with 1 heel raise, protects against excessive dorsiflexion while facilitating the restoration of near-normal gait parameters. This could lead to an accelerated return to function, avoiding the effects of disuse atrophy. This is in contrast to the rigid rocker-bottom AFO design with a greater number of heel-wedge inserts. However, research within a clinical context would be required to ascertain if these biomechanical advantages translate into a functional benefit for patients. The results should also be considered in relation to the amount of force a healing Achilles tendon can withstand.
跟腱断裂治疗方法的进步使得即刻负重方案得以发展。这些方案在使用何种踝足矫形器（AFO）和其中使用的后跟楔形插入数量方面有所不同。
本研究旨在评估不同 AFO 中使用不同数量后跟楔形插入物时的足底压力测量值和时间步态参数。
对照实验室研究。
使用 3 种不同的 AFO 和 4 种不同水平的后跟楔形插入物评估了 15 名健康参与者。因此，共评估了 12 种条件，每种条件均按随机顺序分配给每个参与者。使用鞋内 F-Scan 压力系统测量压力和时间步态参数，使用电子量角器测量运动范围。
设计受限的 AFO 与更多数量的后跟楔形插入物结合使用时，会降低前足压力，增加足跟压力，并减少步态周期终末站立和预摆阶段的时间（P =.029、.002 和.001）。
AFO 设计的选择和后跟楔形插入物的数量对足底压力测量值和时间步态参数有重大影响。这些变化的影响需要应用于急性跟腱断裂的临床管理。这种临床管理需要在保护负重和功能负荷之间取得平衡，这需要在临床环境中进行进一步的研究。
本研究的生物力学数据表明，碳纤维 AFO 配合 1 个后跟抬高可防止过度背屈，同时促进恢复接近正常的步态参数。这可能导致功能更快恢复，避免废用性萎缩的影响。这与具有更多后跟楔形插入物的刚性摇底 AFO 设计形成对比。然而，需要在临床环境中进行研究以确定这些生物力学优势是否转化为患者的功能益处。结果还应考虑愈合跟腱能够承受的力的大小。
