title: The influence of footwear on functional outcome after total ankle replacement, ankle arthrodesis, and tibiotalocalcaneal arthrodesis.
abstract: BACKGROUND
  Gait analysis after total ankle replacement and ankle arthrodesis is usually measured barefoot. However, this does not reflect reality. The purpose of this study was to compare patients barefoot and with footwear.
  
  
  METHODS
  We compared 126 patients (total ankle replacement 28, ankle arthrodesis 57, and tibiotalocalcaneal arthrodesis 41) with 35 healthy controls in three conditions (barefoot, standardized running, and rocker bottom shoes). Minimum follow-up was 2 years. We used dynamic pedobarography and a light gate.
  
  
  METHODS
  relative midfoot index, forefoot maximal force, walking speed.
  
  
  RESULTS
  The relative midfoot index decreased in all groups from barefoot to running shoes and again to rocker bottom shoes (p<0.001). The forefoot maximal force increased wearing shoes (p<0.001), but there was no difference between running and rocker bottom shoes. Walking speed increased by 0.06 m/s with footwear (p<0.001). Total ankle replacement and ankle arthrodesis were equal in running shoes but both deviated from healthy controls (total ankle replacement/ankle arthrodesis smaller RMI p=0.07/0.017; increased forefoot maximal force p=0.757/0.862; slower walking speed p<0.001). In rocker bottom shoes, this ranking remained the same except the relative midfoot index merged to similar values. Tibiotalocalcaneal arthrodesis were inferior in both shoes.
  
  
  CONCLUSIONS
  Runners are beneficial and the benefit is greater for fusions and replacements. Rocker bottom shoes have little added benefit. Total ankle replacement and ankle arthrodesis were equal but inferior to healthy controls. Tibiotalocalcaneal arthrodesis has an inferior outcome.
authors.affiliation: Orthopedic Department, University of Basel, Switzerland. Electronic address: mail@arnofrigg.com.
authors.forename: Frigg
authors.initials: F
authors.lastname: Arno
authors.affiliation: Department of Philosophy, Logic and Scientific Method, London School of Economics, England, UK. Electronic address: r.p.frigg@lse.ac.uk.
authors.forename: Frigg
authors.initials: F
authors.lastname: Roman
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000601:surgery*; D000843:Ankle Joint; D001174:Arthrodesis; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods*; D005260:Female; D005528:Foot / Q000502:physiology*; D005545:Forefoot, Human / Q000502:physiology*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012420:Running; D012775:Shoes; D016138:Walking
keywords: Ankle arthrodesis; Outcome; Pedobarography; Shoe; Tibiotalocalcaneal arthrodesis; Total ankle replacement