title: The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial.
abstract: METHODS
  Randomized 3-treatment, 3-period crossover trial.
  
  
  BACKGROUND
  There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery.
  
  
  OBJECTIVE
  To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery.
  
  
  METHODS
  Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100).
  
  
  RESULTS
  Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; P<.001) wider in the walker boot than in Tubigrip. Self-reported pain was lower in the walker boot (5/100) and in the stirrup brace (13/100) compared to the Tubigrip (18/100, P = .03). No significant differences were found in the effects of the supports on step-length asymmetry between the walker boot or stirrup brace and Tubigrip.
  
  
  CONCLUSIONS
  At 6 weeks after surgical internal fixation for ankle fracture, pain and single-limb support time asymmetry over a short distance and for a short-term walk were immediately reduced with the use of a walker boot use and, to a lesser extent, a stirrup-brace compared to Tubigrip. Step width also widened in a walker boot, which may confer some additional gait stability. These results apply to immediate effects, so studies with longer-term follow-up are now indicated. The trial was registered at http://www.isrctn.com/ (ISRCTN84536917). Level of Evidence Therapy, level 2b.
authors.forename: David J
authors.initials: DJ
authors.lastname: Keene
authors.forename: Keith
authors.initials: K
authors.lastname: Willett
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000534:rehabilitation* / Q000601:surgery; D001915:Braces / Q000706:statistics & numerical data*; D018592:Cross-Over Studies; D005260:Female; D005593:Fracture Fixation, Internal; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010149:Postoperative Pain / Q000517:prevention & control; D016059:Range of Motion, Articular; D016138:Walking; D055815:Young Adult
keywords: Tubigrip; ankle brace; rehabilitation; stirrup brace; walker boot