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Combat-related foot injuries: impact on gait and functional outcome
  1. Loes G M de Kruijff1,2,
  2. M Prins1,3,
  3. A van der Krans4,
  4. R Hoencamp5,6 and
  5. P van der Wurff1
  1. 1Research and Development, Military Rehabilitation Centre Aardenburg, Doorn, The Netherlands
  2. 2De Hoogstraat Rehabilitation, Utrecht, The Netherlands
  3. 3MOVE Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Orthopedic Surgery, Central Military Hospital, Utrecht, The Netherlands
  5. 5Department of Surgery, Central Military Hospital, Utrecht, The Netherlands
  6. 6Department of Surgery, Alrijne Medical Center, Leiderdorp, The Netherlands
  1. Correspondence to Loes G M de Kruijff, Research & Development, Military rehabilitation centre Aardenburg, Doorn, The Netherlands; loesdekruijff{at}gmail.com

Abstract

Introduction Prior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.

Method In nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.

Results Significant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).

Conclusions This study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.

Clinical Trial The Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).

  • rehabilitation medicine
  • trauma management

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Footnotes

  • Contributors All contributors did meet the criteria for authorship.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The Dutch Ministry of Defence do not disclose data to third parties.

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