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A modified passive-dynamic ankle–foot orthosis: can it prevent amputation and arthrodesis in patients with ankle–foot trauma?

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

High-energy lower extremity trauma (HELET) may cause severe damage within the foot–ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle–foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET.

Materials and methods

A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP).

Results

A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore.

Conclusions

Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.

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Data availability

The data sets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank Nicole Benett from Blatchford and her colleagues at DMRC Stanford Hall for sharing their knowledge.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Military Rehabilitation Centre Aardenburg, Korte Molenweg 3, 3941 PW, Doorn, The Netherlands

    Niels Jonkergouw, Loes G. M. de Kruijff, Michiel W. Swaan, Alfred van der Meer & Peter van der Wurff

  2. Clinical Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands

    Niels Jonkergouw

  3. De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Loes G. M. de Kruijff

  4. Biomedical Engineering, University of Twente, Enschede, The Netherlands

    Rogier E. G. Bongers

  5. Rehabilitation Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands

    Herman R. Holtslag

Authors
  1. Niels Jonkergouw
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  2. Loes G. M. de Kruijff
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  3. Rogier E. G. Bongers
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  4. Michiel W. Swaan
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  5. Herman R. Holtslag
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  6. Alfred van der Meer
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  7. Peter van der Wurff
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Contributions

N. Jonkergouw: study design, data acquisition/analysis and interpretation, drafting of manuscript, and final approval. LGM de Kruijff: study design, analysis and interpretation, drafting of manuscript, and final approval. REG Bongers: data acquisition/analysis and interpretation, critical revision, and final approval. MW Swaan: study design, data acquisition, critical revision, and final approval. HR Holtslag: data acquisition, critical revision, and final approval. A van der Meer: data acquisition, critical revision, and final approval. P van der Wurff: data acquisition/analysis and interpretation, critical revision, and final approval.

Corresponding author

Correspondence to Niels Jonkergouw.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Dutch Defence Healthcare. Organization of the Ministry of Defence (MOD) and the Medical Research Ethical Council (METC Brabant no NW2020-37).

Informed consent

All participants signed an informed consent form before their data was included in the study.

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Jonkergouw, N., de Kruijff, L.G.M., Bongers, R.E.G. et al. A modified passive-dynamic ankle–foot orthosis: can it prevent amputation and arthrodesis in patients with ankle–foot trauma?. Arch Orthop Trauma Surg 142, 2719–2726 (2022). https://doi.org/10.1007/s00402-021-04083-9

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  • DOI: https://doi.org/10.1007/s00402-021-04083-9

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