Background: This study aims to reveal surgical treatment's effect on plantar load restoration and clinical outcomes compared to conservative treatment in intra-articular calcaneal fractures.
Methods: Thirty-two patients (Group 1) who underwent surgery for unilateral intra-articular calcaneal fractures and 28 patients who received conservative treatment (Group 2) were included in the study. Detailed static pedobarography examinations were performed on all patients. Plantar load distribution was evaluated based on the forefoot maximum and mean pressure, hindfoot maximum and mean pressure, and distribution of pressure in the heel area in the mediolateral direction. Clinical results were evaluated with the American orthopedic foot and ankle association (AOFAS) score and visual analog scale (VAS) scores.
Results: While the mean contact area between injured and non-injured sides did not differ in Group 1, there was a significant difference between the two sides in Group 2 (p=0.009). Furthermore, on the injured side, the mean contact area (p=0.023) and forefoot pressures (p<0.001) were significantly higher in Group 2 compared to Group 1. Hindfoot pressure on the injured side was significantly lower in Group 2 compared to the uninjured side (p<0.001) and the injured side in Group 1 (p<0.001). A significant anterolateral shift in plantar load was detected in Group 2 (p<0.001). There was a significant difference between the two groups in terms of mean VAS and AOFAS scores in favor of Group 1 (p<0.001).
Conclusion: Surgical treatment of calcaneus intra-articular fractures should be preferred primarily as it provides better clinical results and better plantar load distribution in midterm follow-up.