Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Gladish, Jonathan R.; Powell, Douglas W.; Allison, Lindsey E.; Queen, Robin M.

doi:10.1002/jor.23585

Cited by 7 publications

(3 citation statements)

References 41 publications

(90 reference statements)

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“…20 Similarly, when comparing ankles with untreated osteoarthritis versus unaffected ankles, researchers found that the unaffected ankle compensated for deviations in anterior to posterior position and is relied upon to make postural adjustments. 14,33 These findings regarding differences in flexibility and balance are consistent with the perceptions of patients in this study.…”

Section: Discussionsupporting

confidence: 89%

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

et al. 2021

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Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

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Section: Discussionsupporting

confidence: 89%

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

et al. 2021

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“…Gladish et al, studied center of pressure profiles in unilateral compared to bilateral end-stage ankle osteoarthritis patients. They suggested that center of pressure is a better measure of postural strategy while center of mass measures may be more representative of postural steadiness [ 43 ]. However, many authors use the COG measurement in assessing the statics of musculoskeletal biomechanics [ 9 – 11 , 31 – 33 ].…”

Section: Discussionmentioning

confidence: 99%

Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation

et al. 2018

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BackgroundA number of various techniques were proposed to stabilized ankle arthrodesis, among them external and internal fixation. Appropriate balance and adequate distribution of lower limb loads determine normal biomechanics of the locomotor system. We hypothesized that various techniques used to stabilize ankle arthrodesis may exert different effects on (1) balance and (2) distribution of lower limb loads.MethodsRetrospective analysis included 47 patients who underwent ankle arthrodesis with external stabilization with Ilizarov fixator (group 1, n = 21) or internal stabilization with screws (group 2, n = 26) between 2007 and 2015. Balance and distribution of lower limb loads were determined with a pedobarographic platform.ResultsIn group 1, average load of the operated and non-operated limb amounted to 48.8% and 51.2%, respectively, and in group subjected to internal stabilization to 48.4% and 51.6%, respectively. Neither the intragroup nor the intergroup differences in the distribution of lower limb loads were statistically significant. Mean length of the center of gravity (COG) path was 137.9 cm for group 1 and 134 cm for group 2, and mean COG area amounted to 7.41 cm2 and 6.16 cm2, respectively. The latter intergroup difference was statistically significant.ConclusionsBalance after ankle arthrodesis with Ilizarov fixation is worse than after the same procedure with internal stabilization. Despite correction of ankle deformity, musculoskeletal biomechanics still remains impaired. While ankle fusion with either Ilizarov or internal fixation provide appropriate distribution of lower limb loads, none of these procedures normalize patients’ balance.

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“…15 Little is currently known about the path of the COP in patients with ankle OA. There has been one analysis of COP during standing 27 and two during walking in OA patients using plantar pressure to quantify COP. 28,29 The former study reported that reduced loading under the heel and toes in ankle OA patients while the latter reported change in midfoot load in OA patients with surgical repair compared to healthy subjects.…”

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confidence: 99%

The effect of ankle osteoarthritis and total ankle arthroplasty on center of pressure position

Zeininger

Schmitt

Hughes-Oliver

et al. 2020

Journal Orthopaedic Research

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Total ankle arthroplasty (TAA) is a common surgical approach for patients with end‐stage ankle osteoarthritis (OA). However, very little is known about the path of the center of pressure (COP) of the foot, and thus important aspects of load transfer, muscle mechanical advantage, and balance, in patients before or after surgery. The objective of this study was to trace the pathway of the COP under the foot in patients with symptomatic ankle OA, comparing asymmetry between affected and unaffected limbs. From force plate data, proximodistal and mediolateral positions of the COP beneath the foot were calculated and compared for the affected and unaffected foot in patients with unilateral ankle OA (N = 93) before and after TAA. Gender and age at surgery had little or no effect in this study. Patients with ankle OA had minimal COP position asymmetry before surgery, and this asymmetry was reduced following surgery. Before surgery, patients had a slower walking speed and a shorter path of the COP which began relatively distal to the heel and ended relatively proximal to the hallux. TAA increased the proximodistal distance the COP traveled under both the unaffected and affected foot, a pattern that was maintained for over 2‐year postsurgery. TAA allows patients with ankle OA to maintain a longer COP path than they had before surgery on both sides that is closer to that reported for unaffected individuals, extending effectively from the heel to the hallux, potentially improving pedal mechanics.

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Center of pressure profiles in unilateral compared to bilateral end‐stage ankle osteoarthritis patients

Cited by 7 publications

References 41 publications

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

Pedobarographic analysis of body weight distribution on the lower limbs and balance after ankle arthrodesis with Ilizarov fixation and internal fixation

The effect of ankle osteoarthritis and total ankle arthroplasty on center of pressure position

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