Original Research| Volume 56, ISSUE 6, P1151-1157, November 2017

Foot Pressure Changes Before and After Ankle Fusion: A Pedobarograph Study


      We performed a case-control study with the purpose of establishing the pressure patterns in the soles of the feet of patients with ankle osteoarthritis, determining whether the pattern changed after treating the arthritis with ankle joint fusion (arthrodesis), and whether the change is significant. We also studied the benefits of ankle fusion with respect to the Short-Form 36-item Health Survey and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale. The study included 18 participants (9 in the study group and 9 in the control group) to reach statistical significance with a 95% confidence interval (CI). A demonstrable increase was found in both forefoot and hind-foot pressures in the study group preoperatively compared with the control group. Also, a demonstrable increase was found in the pressure in both the forefoot (mean difference 50.56 ± 267.39 kPa) and the hindfoot (mean difference 57.44 ± 160.27 kPa) from preoperatively to postoperatively. This difference was not statistically significant (p = .59 [t(8) = 0.57]; 95% CI 256.10 to −154.98) for the forefoot pressures and for the hindfoot pressures (p = .31 [t(8) = 1.08]; 95% CI 180.64 to −65.76). The Short-Form 36-item scores significantly improved from preoperatively to postoperatively (p = .000054 for the physical component and p = .018 for the mental component). The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score also improved significantly (p = .0000005). The foot pressures, as measured by using the insole sensors, showed an increase in forefoot and hindfoot pressures that was not statistically significant.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hennig E.M.
        Pedobarograph assessment in gait analysis.
        in: State of the Art Reviews: Physical Medicine and Rehabilitation. vol. 16. Henley & Belfus, Philadelphia2002: 215-229
        • Cavanagh P.R.
        • Rodgers M.M.
        • Liboshi A.
        Pressure distribution under symptom-free feet during barefoot standing.
        Foot Ankle. 1987; 7: 262-276
        • Brown M.
        • Rudicel S.
        • Esquanazi A.
        Measurement of dynamic pressures at the shoe-foot interface during normal walking with various foot orthoses using the FSCAN system.
        Foot Ankle Int. 1996; 17: 152-156
        • Costa M.L.
        • Kay D.
        • Donell S.T.
        Gait abnormalities following rupture of the tendo Achilles: a pedobarograpic assessment.
        J Bone Joint Surg Br. 2005; 87: 1085-1088
        • Fishco W.D.
        • Cornwall M.W.
        Gait analysis after talonavicular joint fusion: 2 case reports.
        J Foot Ankle Surg. 2004; 43: 241-247
        • Bowyer G.W.
        The ankle and foot.
        in: Solomon L. Warwick D. Nayagam S. Apley's System of Orthopaedics and Fractures. ed 9. Hodder Arnold, London, UK2010: 587-624
        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        • Nunley J.A.
        • Myerson M.S.
        • Sanders M.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 349-353
        • Ibrahim T.
        • Beiri A.
        • Azzabi M.
        • Best A.J.
        • Taylor G.J.
        • Menon D.K.
        Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.
        J Foot Ankle Surg. 2007; 46: 65-74
      1. 36-Item Short Form Survey [S-36] RAND HEALTH Web. Available at: Accessed November 7, 2016.

        • Nyska M.
        • Sofer D.
        • Porat A.
        • Howard C.B.
        • Levi A.
        • Meizner I.
        Planter foot pressures in pregnant women.
        Isr J Med Sci. 1997; 33: 139-146
        • Armstrong D.G.
        • Lavery L.A.
        • Bushman T.R.
        Peak foot pressures influence the healing time of diabetic foot ulcers treated with total contact casts.
        J Rehabil Res Dev. 1998; 35: 1-5
        • Bauman J.H.
        • Girling J.P.
        • Brand P.W.
        Plantar pressures and trophic ulceration: an evaluation of footwear.
        J Bone Joint Surg Br. 1963; 45: 652-673
        • Kato H.
        • Takada T.
        • Kawamura T.
        • Hotta N.
        • Torji S.
        The reduction and redistribution of plantar pressures using foot orthoses in diabetic patients.
        Diabetes Res Clin Pract. 1996; 31: 115-118
        • Van Schie C.
        • Ulbrecht J.S.
        • Becker M.B.
        • Cavanagh P.R.
        Design criteria for rigid rocker shoes.
        Foot Ankle Int. 2000; 21: 833-844
        • Blomgren M.
        • Turan I.
        • Agadir M.
        Gait analysis in hallux valgus.
        J Foot Surg. 1991; 30: 70-71
        • Nyska M.
        • McCabe C.
        • Linge K.
        • Klenerman L.
        Plantar foot pressures during treadmill walking with high-heel and low-heel shoes.
        Foot Ankle Int. 1996; 17: 662-666
        • Kernozek T.
        • Roehrs T.
        • McGarvey S.
        Analysis of plantar loading parameters pre and post surgical intervention for hallux valgus.
        Clin Biomech (Bristol, Avon). 1997; 12: S18-S19
        • Milani T.L.
        • Retzlaff S.
        Analysis of pressure distribution for the evaluation of gait in patients with hallux valgus surgery.
        Z Orthop Ihre Grenzgeb. 1995; 133: 341-346
        • Samnegard E.
        • Turan I.
        • Lanshammar H.
        Postoperative evaluation of Keller’s arthroplasty and arthrodesis of the first metatarsophalangeal joint using the EMED gait analysis system.
        J Foot Surg. 1991; 30: 373-374
        • Saltzman C.L.
        • Salamon M.L.
        • Blanchard G.M.
        • Huff T.
        • Hayes A.
        • Buckwalter J.A.
        • Amendola A.
        Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopedic center.
        Iowa Orthop J. 2005; 25: 44-46
        • Grass R.
        • Rammelt S.
        • Endres T.
        • Zwipp H.
        Reorientational arthrodesis of the ankle joint using four screws.
        Orthopade. 2005; 34: 1209-1215
        • Armstrong D.G.
        • Peters E.J.
        • Athanasiou K.A.
        • Lavery L.A.
        Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration?.
        J Foot Ankle Surg. 1998; 37: 303-307
        • Lavery L.A.
        • Armstrong D.G.
        • Wunderlich R.P.
        • Tredwell J.
        • Boulton A.J.
        Predictive value of foot pressure assessment as part of a population-based diabetes disease management program.
        Diabetes Care. 2003; 26: 1069-1073