Improvement of gait by using orthotic insoles in patients with heel injury who received reconstructive flap operations

Objective: To investigate the effect of orthotic insoles in heel injury patients who received reconstructive flap operations. Design: Motion analysis and force platform data were collected in able-bodied subjects and patients with heel injuries during walking without and with the use of the total contact insole. Gait kinetics were collected for the hip, knee, and ankle joints and then compared with Student's t tests. Results: Walking velocity and step length were decreased (P < 0.014 and P < 0.005) for patients not wearing the total contact insole. The affected limbs had longer double-support duration (14.8% of gait cycle, P < 0.037) and shorter single-support duration (34.5% of gait cycle, P < 0.045). Less hip power generation was noted for the affected limbs during both initial contact and preswing phases, 0.17 ± 0.10 N-m/kg-m and 0.45 ± 0.20 N-m/kg-m, as compared with that of the able-bodied subjects, 0.36 ± 0.08 N-m/kg-m and 0.89 ± 0.22 N-m/kg-m, respectively. Decreased ankle power generation was noted for the affected limbs (1.08 ± 0.38 N-m/kg-m) during preswing phase as compared with the able-bodied subjects (2.24 ± 0.33 N-m/kg-m). After fitting of the total contact insole, the affected limbs recovered to a gait pattern similar to that of the able-bodied subjects (P < 0.05). Conclusion: Asymmetry of gait pattern after heel injury resulted in altered gait kinetics. Gait symmetry could be recovered in these patients as the total contact insole provides weight acceptance, shock absorption, and cushioning effect for the reconstructed heels.