Extracorporeal Shock Wave Therapy Of Osteochondral Lesions Of The Talus Based On Gait Analysis

Objective:Osteochondral lesions of the talus is one of the main factors for chronic pain of the ankle.The patient's function is significantly reduced,which seriously affects the quality of life.The current treatment of osteochondral lesions of the talus,including conservative treatment and surgery.Conservative treatment includes rest to avoid weight-bearing activities,local braking,taking non-steroidal anti-inflammatory drugs,etc.The conservative treatment cycle is long and the patient is difficult to cooperate.The patient's pain cannot be significantly relieved,and satisfactory treatment results cannot be achieved.Surgical treatment is not easy to accept because of its traumatic and costly nature.Extracorporeal shock wave,as a non-invasive and simple treatment method,has good clinical effects on tendon end disease and bone and joint pain.Gait analysis has a guiding role in guiding postoperative rehabilitation and evaluating the effect of treatment.In this paper,extracorporeal shock waves are used to treat talar osteochondral injury.The treatment results are quantified by means of a plantar pressure analysis system.The effects of extracorporeal shock waves on talar osteochondral injury and the gait changes before and after treatment are discussed.Methods:Fourty patients with OLT selected from March 2019-July2019 were randomly and equally divided into experimental group and control group.The treatment involved 1.8-2.5bar,5 Hz,2000-3000 shocks every time.The energy is adjusted according to the patient's adaptability.Once every two days,6 times were taken as a course of treatment.The control group was treated with non-steroidal anti-inflammatory drugs.The patients were followed up at three months after treatment which was evaluated by the patients'ankle VAS pain score,the American Orthopaedic Foot and Ankle Society(AOFAS)Ankle and Hindfoot Score,the sagittal lesion area by MRI,and plantar pressure was measured using Footscan system.Results:1.Before treatment,there was no significant difference in VAS pain scores between the experimental and control groups(P>0.05).After the treatment,the VAS pain scores of the two groups were significantly improved than before treatment(P<0.05)The patient's pain symptoms were reduced.Compared with the control group,the VAS pain score of the experimental group improved significantly after treatment,and the difference was statistically significant(P<0.05);2.Before treatment,there was no significant difference in the AOFAS functional score between the experimental group and the control group(P>0.05).After 3 months of treatment,the AOFAS functional score of the two groups was significantly improved than before treatment(P<0.05),the improvement of ankle function of the ankle joint in the experimental group was better than that in the control group,and the difference was statistically significant(P<0.05);3.After the treatment for 3months,compared to pre-treatment,MRI showed experimental lesion area(2.03±0.72)cm~2 significantly reduced,the difference was statistically significant(P<0.05),the control control MRI lesion area(2.65±1.04)cm~2before treatment with no significant difference(P>0.05),two groups of patients before treatment MRI showed no significant difference in lesion area(P>0.05);4.Before treatment,there was no significant difference in the subtalar joint range of the affected lower limb,the maximum and average pressure of the affected foot during walking,and the percentage of each support period in the gait analysis of the two groups.After 3 months of treatment,the subtalar joint range(16.58±4.36)°in the experimental group and the subtalar joint range(13.69±4.01)°in the control group were significantly improved,the difference was statistically significant(P<0.05),and The improvement in the experimental group was significant compared with the control group(P<0.05).After treatment,the Heel strike period of the experimental group was shortened,and the Midstance period was prolonged.The Midstance period of the control group was extended.The Midstance period of the experimental group was better than that of the control group(P<0.05).The maximum pressure and mean pressure of the affected foot were increased during the walking(P<0.05).The maximum and average pressure of the affected foot during walking was increased(P<0.05).Conclusion:The OLT patient's affected lower limb support capacity and ankle range of motion are significantly reduced.Using the biological effect of extracorporeal shock waves can reduce patient pain and improve patient ankle function.The weight-bearing ability of the tissue and its surroundings improves the patient's walking ability and improves the patient's quality of life.