title: Functional rehabilitation with a foot plate modification for circular external fixation.
abstract: BACKGROUND
  Customized foot plates attached to the foot ring of an ankle-spanning circular external fixator present a unique opportunity for patients undergoing complex lower-extremity limb salvage to participate in highly advanced weight-bearing physical therapy. The purpose of this study was to identify the rehabilitation capabilities afforded by this external fixator modification.
  
  
  METHODS
  Surgical logs and radiographs were reviewed to identify all lower-extremity limb salvage patients from February 2008 to December 2010 treated with an ankle-spanning circular external fixator and a customized foot plate treated by the same orthopedic surgeon and enrolled in our institution's Return To Run clinical pathway. Medical records were reviewed to identify a series of exercises that each patient was able to perform.
  
  
  RESULTS
  Eleven patients were identified. All patients were treated by the same physical therapist. All 11 patients were able to bear full weight on their foot plates and perform regular and split squats. Six of 11 patients were able to ambulate unassisted, and 5 patients required a cane. All 11 patients could navigate stairs and use an elliptical and stair-stepping machine. Six of 11 patients could perform single-leg hack squats. Eight of 11 patients were able to perform double-leg shuttle jumps, although only 5 of 11 patients could perform single-leg shuttle jumps. Five of 11 patients were able to perform a single-leg balance. Only 1 patient was able to run on the foot plate.
  
  
  CONCLUSIONS
  Patients undergoing lower-extremity limb salvage with an ankle-spanning circular external fixator and a customized foot plate were able to participate in highly advanced weight-bearing physical therapy exercises during the osseous and soft-tissue healing process.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA. james.blair@amedd.army.mil
authors.forename: James A
authors.initials: JA
authors.lastname: Blair
authors.forename: Johnny G
authors.initials: JG
authors.lastname: Owens
authors.forename: Joey
authors.initials: J
authors.lastname: Saucedo
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Hsu
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001753:Blast Injuries / Q000601:surgery; D004867:Equipment Design; D016267:External Fixators; D005360:Fibula / Q000293:injuries / Q000601:surgery*; D050723:Fractures, Bone / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000534:rehabilitation* / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery; D055815:Young Adult
keywords: Ilizarov; Return To Run; Taylor spatial frame; foot plate; limb salvage