Effects of wedge-shaped heel pad in the treatment of extremely severe burn patients with foot drop deformity

Objective To explore the effects of wedge-shaped heel pad in the treatment of foot drop deformity in extremely severe burn patients. Methods A retrospective cohort study method was con⁃ ducted. From March 2015 to July 2016, 33 patients with foot drop deformity caused by extremely severe burn scar who met the inclusion criteria were admitted to the Department of Burn Rehabilitation of Kunshan Reha⁃ bilitation Hospital, including 18 males and 15 females, aged (38±9) years. Patients received comprehensive post-burn rehabilitation treatment after admission, and the wedge-shaped heel pad with appropriate height was placed under the patients' insole, according to the degree of the foot drop deformity in patients. Stand⁃ ing, squatting, and walking exercises were performed after putting on shoes with wedge-shaped heel pad. Be⁃ fore and immediately after the first treatment (hereinafter referred to as before and immediately after treat⁃ ment), and in 1 month after treatment with wedge-shaped heel pad, the Simple Balance Scale was used to evaluate the standing balance ability of patients. In 1, 3, and 12 months after treatment, active ranges of mo⁃ tion (AROMs) of bilateral ankle joint dorsiflexion and knee joint flexion were measured with joint motion range measuring ruler, the shortest distance between buttocks of patients and the ground when squatting and walking distance in 1 min of patients were measured with measuring tape, and the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ac⁃ tivity of daily living (ADL) in patients were evaluated with modified Barthel index. Data were statistically an⁃ alyzed with Friedman test, Wilcoxon rank sum test, unequal interval analysis of variance for repeated mea⁃ surement, and Bonferroni correction. Results Immediately after treatment, the standing balance ability of patients was 2.0 (1.0, 2.0) levels, which was significantly higher than 1.0 (0, 1.0) level before treatment (Z= −5.568, P<0.01); in 1 month after treatment, the standing balance ability of patients was 3.0 (2.5, 3.0) levels, which was significantly higher than that immediately after treatment (Z= − 5.303, P<0.01). In 3 and 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and the left and right knee joint flexion in patients were significantly increased compared with those in 1 month after treatment (Z=−4.860, −4.836, −4.965, −4.909, −5.037, −5.025, −5.020, −4.942, P<0.01); in 12 months after treatment, AROMs of the left and right ankle joint dorsiflexion and knee joint flexion in patients were significantly increased com ⁃ pared with those in 3 months after treatment (Z= − 5.062, − 4.962, − 5.017, − 4.944, P<0.01). In 3 and 12 months after treatment, the shortest distances between buttocks of patients and the ground were (67±11) and (57±11) cm, which were significantly shorter than (72±11) cm in 1 month after treatment (P<0.01), respec⁃ tively; in 12 months after treatment, the shortest distance between buttocks of patients and the ground was significantly shorter than that in 3 months after treatment (P<0.01). In 3 and 12 months after treatment, the walking distances within 1 min of patients were significantly longer than that in 1 month after treatment (Z= −5.043, −5.016, P<0.01); in 12 months after treatment, the walking distance within 1 min of patients was sig⁃ nificantly longer than that in 3 months after treatment (Z=−5.025, P<0.01). In 3 and 12 months after treat⁃ ment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z=−4.472, −4.025, −4.707, −4.565, −3.994, −4.777, P<0.01); in 12 months after treatment, the independent ability of transferring between beds and chairs, walking, and walking up and down stairs in the movement items of ADL in patients were significantly increased compared with those in 1 month after treatment (Z= − 3.827, − 3.358, − 3.557, P<0.01). Conclusions After using the wedge-shaped heel pad, the standing balance ability, ankle joint dorsiflexion range of motion, walking ability are significantly im⁃ proved, and the independent levels of movement items in ADL are significantly increased in extremely se⁃ vere burn patients with foot drop deformity.