title: Effect of Custom Orthosis and Rehabilitation Program on Outcomes Following Ankle and Subtalar Fusions.
abstract: BACKGROUND
  Fractures of the distal tibia, ankle, and foot sustained through a high-energy mechanism can be extremely debilitating, and ankle and/or subtalar fusion may be indicated if the limb is deemed salvageable. Functional outcomes among this population are often poor. The purposes of this study were to evaluate the effect of an advanced rehabilitation program combined with the use of a custom ankle-foot orthosis for patients with ankle or subtalar fusion on selected physical performance measures and patient-derived outcome measures and to determine if the response to treatment was predicated upon the type of fusion.
  
  
  METHODS
  We conducted a prospective, longitudinal, observational, cohort study composed of 23 active duty Service Members treated for lower extremity trauma. Patients were separated into 2 groups: group 1 was composed of 12 patients who underwent isolated ankle fusion or ankle fusion combined with ipsilateral subtalar fusion, group 2 was composed of 11 patients who underwent subtalar fusion only. Patient-reported outcome (PRO) measures and physical performance measures were recorded at baseline and at the conclusion of the rehabilitation program.
  
  
  RESULTS
  Significant improvements in both groups were seen in each of the 4 physical performance measures. Only group 2 showed significant improvements in all domains of the Veteran's Rand 12-Item Health Survey (VR-12) and Short Musculoskeletal Function Assessment (SMFA) at all points during the course of rehabilitation.
  
  
  CONCLUSIONS
  Among a subset of patients treated for severe lower extremity trauma with ankle and/or subtalar fusion, an integrated orthotic and rehabilitation initiative improved physical performance and PRO measures over an 8-week course.
  
  
  METHODS
  Level III, prospective comparative series.
authors: San Antonio Military Medical Center, Fort Sam Houston, TX, USA ajsheean@gmail.com.
authors: Andrew J
authors: AJ
authors: Sheean
authors: San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors: David J
authors: DJ
authors: Tennent
authors: San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors: Johnny G
authors: JG
authors: Owens
authors: San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors: Jason M
authors: JM
authors: Wilken
authors: Carolinas Medical Center, Charlotte, NC, USA.
authors: Joseph R
authors: JR
authors: Hsu
authors: United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
authors: Daniel J
authors: DJ
authors: Stinner
mesh_terms: D000842:Ankle; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D050723:Fractures, Bone / Q000503:physiopathology*; D006801:Humans; D009989:Orthotic Devices / Q000592:standards*; D011446:Prospective Studies; D012046:Rehabilitation; D013380:Subtalar Joint / Q000503:physiopathology / Q000601:surgery*
keywords: arthritis; hindfoot fusion; outcome studies; rehabilitation