Eidmann Annette, Kraftborn Katharina, Walcher Matthias G, Fraißler Lukas, Rudert Maximilian, Stratos Ioannis
Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Wuerzburg, Germany.
OCW Orthopädie Chirurgie Wuerzburg, Wuerzburg, Germany.
Foot Ankle Orthop. 2025 Jun 3;10(2):24730114251338848. doi: 10.1177/24730114251338848. eCollection 2025 Apr.
Arthroscopic ankle arthrodesis (AAA) is a standard procedure for end-stage osteoarthritis of the ankle. One of the main concerns after AAA remains the development of secondary osteoarthritis in the subtalar and tarsal joints in the long term. This development is thought to be due to a compensatory increased mobility and therefore increased load on the adjacent joints. Therefore, the aim of the study was to analyze the residual motion of the tarsal joints, the load distribution under the foot, and the influence of tarsal joint motion on load distribution and gait pattern after AAA.
29 patients with arthroscopic AAA were analyzed in a retrospective case-control series by pedobarographic gait analysis and fluoroscopy. The variables examined by pedobarography included peak force, peak pressure, and contact time of 10 different zones of the foot during the roll-over process, comparing the operated with the contralateral healthy foot. The range of motion (ROM) of the subtalar and medial tarsal joints in dorsiflexion/plantarflexion were assessed radiologically.
After AAA, peak forces of the ipsilateral foot were significantly reduced for the entire foot and especially the first metatarsal, great toe, and lesser toes during the roll-over process. Peak pressure decreased significantly under the lesser toes and increased under metatarsal 5, without significant load alterations under the mid- and hindfoot. The residual ROM of the subtalar and tarsal joints in dorsiflexion/plantarflexion was 23.5 degrees. The greater the ROM of the adjacent joints, the more the gait pattern normalized.
Load distribution during the stance phase is influenced by AAA; the ROM of the subtalar and midfoot joints is essential in normalizing gait pattern.
IV, case series.
关节镜下踝关节融合术（AAA）是终末期踝关节骨关节炎的标准手术。AAA术后的主要问题之一仍然是长期来看距下关节和跗骨间关节继发性骨关节炎的发展。这种发展被认为是由于代偿性活动增加，因此相邻关节的负荷增加。因此，本研究的目的是分析AAA术后跗骨间关节的残余运动、足部的负荷分布以及跗骨间关节运动对负荷分布和步态模式的影响。
通过足压计步态分析和荧光透视，对29例行关节镜下AAA手术的患者进行回顾性病例对照研究。足压计检查的变量包括在翻转过程中足部10个不同区域的峰值力、峰值压力和接触时间，将患侧与对侧健康足进行比较。通过影像学评估距下关节和内侧跗骨间关节背屈/跖屈的活动范围（ROM）。
AAA术后，患侧足在翻转过程中整个足部尤其是第一跖骨、大脚趾和小脚趾的峰值力显著降低。小脚趾下的峰值压力显著降低，第五跖骨下的峰值压力增加，中足和后足的负荷无显著变化。距下关节和跗骨间关节背屈/跖屈的残余ROM为23.5度。相邻关节的ROM越大，步态模式越趋于正常。
站立期的负荷分布受AAA影响；距下关节和中足关节的ROM对步态模式正常化至关重要。
IV，病例系列。
