The influence of footwear on functional outcome after total ankle replacement, ankle arthrodesis, and tibiotalocalcaneal arthrodesis

- Barefoot and in shoes, ankle arthrodesis, and total ankle replacement are far from healthy values.
- Running shoes are as good as rocker bottom shoes.
- Total ankle replacement has the same increased forefoot maximal force as ankle arthodesis.
- People walk faster with shoes and relative differences become smaller in shoes.
- Tibiotalocalcaneal arthrodesis is by far the least successful treatment barefoot and in shoes.

BackgroundGait 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.MethodsWe 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. Main outcome measures: relative midfoot index, forefoot maximal force, walking speed.FindingsThe 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.InterpretationRunners 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.