• Arch Orthop Trauma Surg · Oct 2022

    A modified passive-dynamic ankle-foot orthosis: can it prevent amputation and arthrodesis in patients with ankle-foot trauma?

    • Niels Jonkergouw, de KruijffLoes G MLGMMilitary Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands.De Hoogstraat Rehabilitation, Utrecht, The Netherlands., Rogier E G Bongers, Michiel W Swaan, Herman R Holtslag, Alfred van der Meer, and Peter van der Wurff.
    • Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands. n.jonkergouw@mrcdoorn.nl.
    • Arch Orthop Trauma Surg. 2022 Oct 1; 142 (10): 271927262719-2726.

    IntroductionHigh-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET.Materials And MethodsA retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP).ResultsA significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore.ConclusionsPatients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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