SLR - March 2017 - Brandon Tucker

Shorter Recovery Can Be Achieved from Using Walking Boot After Operative Treatment of an Ankle Fracture

Reference: Amaha K, Arimoto T, Saito M, Tasaki A, Tsuji S. Shorter Recovery Can Be Achieved from Using Walking Boot After Operative Treatment of an Ankle Fracture. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology. 2017(7): 10–14.

Scientific Literature Review

Reviewed By: Brandon Tucker, DPM
Residency Program: University Hospital, Newark, NJ

Podiatric Relevance: Ankle fractures are a common traumatic injury that foot and ankle surgeons may treat. The postoperative course is fraught with attempts to get the patient performing range of motion exercises, or trying to persuade the patient to stay nonweightbearing longer or explaining to the patient why s/he needs to stay off the ankle while it is healing. This study postulates that perhaps patients can start weightbearing sooner than we think with use of a rocker-bottom walking boot. It evaluates their postoperative course comparing those in a rocker-bottom walking boot to those who stayed nonweightbearing.

Methods: This study is a retrospective cohort study with 47 patients (mean age 53.9 +/- 12) who underwent surgical correction of an unstable ankle fracture between January 2008 to October 2014. The groups were divided with 25 patients in a plaster cast postoperatively and 22 patients in a rocker-bottom walking boot postoperatively. They included all unstable ankle fractures, including single malleolar, bimalleolar and trimalleolar. They excluded pilon fractures, open fractures, polytrauma, history of previous ankle surgery or those unable to adhere to the postop protocol. The ankles were fixated utilizing AO principles with plates and screws. Their postop protocol was similar for each group until days seven to 10 when the sutures removed. Until then, patients were treated with a half cast. After sutures were removed, one group was put in a plaster cast and the other in a walking boot. They were seen weekly by physiotherapsists and told to do exercises daily. X-rays were taken at 14 days postop, six weeks, three months and six months. The primary measures included time to stand unipedal on affected side after being allowed to full-weight bear, time it took to walk without crutches and final range of motion of the affected ankle. Additionally, they recorded the type of internal fixation, operative duration, time allowed to put full weight, postop loss of reduction and nonunions.

Results: Patients in the walking boot with a rocker bottom showed faster functional recovery, which allowed the patients to return to normal activities faster. The walking boot group showed shorter time to stand unipedal and shorter time to walk without crutches. There was no significant difference in final range of motion between the two groups. There were similar types of fixation between the two groups, no significant difference in operative time, no significant difference in time patients were allowed to weight bear, no loss of reduction postop and no nonunions.

In this study, patients who were allowed to start protective weightbearing in a rocker-bottom walking boot after removal of sutures had superior functional recovery with quicker time to stand unipedal on the affected limb and shorter time to walking without crutches. This allowed patients to return to their normal lives faster. It demonstrated that, with appropriate fixation, ankle fractures are able to endure loads while the ankle is in a protected walking boot without loss of reduction or resultant nonunions. 

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