Ankle plantar flexor muscle performance and patient reported outcomes in people following total ankle arthroplasty


      • Preoperative ankle power generation was not different following surgery.
      • Ankle power generation was less than control values postoperatively.
      • Postoperative ankle power, strength, and gait speed were directly correlated.
      • Postoperative power and strength predicted longer-term patient reported outcomes.
      • Ankle muscle performance may be an important postoperative clinical target.



      The purpose of this study was to prospectively evaluate ankle power generation during gait in people with total ankle arthroplasty, and examine the relationships between postoperative plantar flexor strength, ankle power, and patient outcomes.


      Nineteen people with end-stage ankle arthritis who received a total ankle arthroplasty and 19 healthy matched controls participated in this case-control study. Patient reported outcomes included a region specific measure of foot function and a generic measure of physical function. Gait speed was recorded with the 6-min walk test. Isokinetic plantar flexor strength was measured with an instrumented dynamometer. Motion capture and force plate data were used to calculate peak ankle power generation during walking. Paired or independent t-tests were used to compare ankle power across time and between groups, respectively. Bivariate correlations were performed to examine the interplay of postoperative strength, ankle power, gait speed, and patient reported outcomes.


      Ankle power was not different between the preoperative and 6-month postoperative time points (d = 0.20). Six-month postoperative ankle power was less than controls (d = 1.32). Strength, ankle power, and gait speed were directly correlated in the patient group 6-months postoperatively (r or ρ ≥ 0.47). Six-month postoperative strength and ankle power were directly correlated to select 2-year patient reported outcomes (both ρ = 0.54).


      Lower than normal 6-month postoperative ankle power, which was correlated to strength, gait speed, and longer-term patient reported outcomes, suggests efforts toward improving ankle plantar flexor muscle performance may improve patient outcomes.


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