Recovery of gait after ankle fracture surgery following early mobilization and weight-bearing

Abstract

BACKGROUND: Ankle fractures are among the most common fractures in adults. Despite significant advancements in surgical techniques, the postoperative treatment regimens remain conservative. This study aims to objectively evaluate gait recovery following early mobilization and weight-bearing after surgical ankle fracture treatment using instrumented gait analysis. METHODS: This prospective, single-armed, longitudinal study enrolled adult patients following surgical treatment for isolated ankle fractures with early pain dependent weightbearing. Gait analysis, utilizing a treadmill integrated with a pressure plate and IMU-based motion capture systems, was conducted at 6 weeks, 3-, 6-, and 12-months post-surgery, assessing spatio-temporal and kinematic parameters. Results were compared longitudinally and against a healthy control group. RESULTS: Longitudinal data were available for 44 patients. Significant (p<.001) improvements of self-paced walking velocity (SPV) were observed from 6 weeks (2.2 ± 1.1 km/h), to 3 (2.9 ± 0.9 km/h) and 6 months (3.4 ± 0.9 km/h). The spatio-temporal parameters showed significant changes between 6 weeks and all further time points only at SPV. Kinematic parameters showed significant longitudinal improvements at SPV for hip, knee, and ankle motion (including all three ankle planes). Patient gait parameters at 6 and 12 months were comparable to healthy controls, except for persistent limitations in ankle sagittal kinematics. CONCLUSION: Patients undergoing surgical ankle fracture repair with early mobilization and full weight-bearing showed substantial gait recovery within 6 weeks. By 12 weeks, patient gait closely resembled healthy controls, highlighting the efficacy of a pain-adapted postoperative regimen for rapid functional recovery and return to previous activity levels. LEVEL OF EVIDENCE: Level II.