An Evaluation of Surgical Functional Reconstruction of the Foot Using Kinetic and Kinematic Systems: A Case Report

J Foot Ankle Surg. 2017 Jan-Feb;56(1):208-216. doi: 10.1053/j.jfas.2016.01.038. Epub 2016 Aug 11.

Abstract

Most pedobarographic studies of microsurgical foot reconstruction have been retrospective. In the present study, we report the results from a prospective pedobarographic study of a patient after microsurgical reconstruction of her foot with a latissimus dorsi flap and a cutaneous paddle, with a 42-month follow-up period. We describe the foot reconstruction plan and the pedobarographic measurements and analyzed its functional outcome. The goal of the present study was to demonstrate that pedobarography could have a role in the treatment of foot reconstruction from a quantitative perspective. The pedobarographic measurements were recorded after the initial coverage surgery and 2 subsequent foot remodeling procedures. A total of 4 pedobarographic measurements and 2 gait analyses were recorded and compared for both the noninvolved foot and the injured foot. Furthermore, the progress of the reconstructed foot was critically evaluated using this method. Both static and dynamic patterns were compared at subsequent follow-up visits after the foot reconstruction. The values and progression of the foot shape, peak foot pressure (kPa), average foot pressure (kPa), total contact surface (cm2), loading time (%), and step time (ms) were recorded. Initially, the pressure distribution of the reconstructed foot showed higher peak values at nonanatomic locations, revealing a greater ulceration risk. Over time, we found an improvement in the shape and values of these factors in the involved foot. To homogenize the pressure distribution and correct the imbalance between the 2 feet, patient-specific insoles were designed and fabricated. In our patient, pedobarography provided an objective, repeatable, and recordable method for the evaluation of the reconstructed foot. Pedobarography can therefore provide valuable insights into the prevention of pressure ulcers and optimization of rehabilitation.

Keywords: pedobarography; plantar flap remodeling; postoperative evaluation; ulcer prevention; weightbearing patterns.

Publication types

  • Case Reports
  • Comparative Study
  • Evaluation Study
  • Review

MeSH terms

  • Accidents, Traffic
  • Adult
  • Biomechanical Phenomena
  • Crush Injuries / diagnostic imaging
  • Crush Injuries / surgery*
  • Female
  • Follow-Up Studies
  • Foot Injuries / diagnostic imaging
  • Foot Injuries / surgery*
  • Graft Survival
  • Humans
  • Injury Severity Score
  • Myocutaneous Flap / blood supply
  • Myocutaneous Flap / transplantation*
  • Orthotic Devices / statistics & numerical data*
  • Plastic Surgery Procedures / methods*
  • Plastic Surgery Procedures / rehabilitation
  • Postoperative Care / methods
  • Recovery of Function
  • Risk Assessment
  • Stockings, Compression
  • Time Factors
  • Treatment Outcome
  • Weight-Bearing
  • Wound Healing / physiology