{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:44:32Z","timestamp":1759970672662,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>There is limited understanding of how well patients adhere to postoperative instructions following ankle surgery, particularly in outpatient settings regarding partial weight bearing (15\u201330 kg) and orthosis use. This study aims to assess orthosis compliance and load frequency over six weeks post-surgery using pressure-sensitive insoles, while also evaluating the effectiveness of continuous biofeedback. A total of 84 patients with isolated ankle fractures were enrolled. All participants were instructed to maintain partial weight bearing of 15\u201330 kg for six weeks with a lower leg orthosis equipped with insoles that continuously recorded daily step counts and maximum loads. In a prospective randomized design, the control group received no biofeedback, while the intervention group received audiovisual feedback whenever loads exceeded 20 kg. Adherence to the prescribed partial weight bearing and orthosis use was low in both groups, with only 10% of the control group wearing the orthosis by week three and overload occurring as early as week one. However, the implementation of biofeedback resulted in significant improvements in orthosis utilization (57.4% vs. 29.1%) and adherence to prescribed loading. The implementation of continuous biofeedback significantly enhanced adherence to prescribed loading and orthosis usage, highlighting its critical role in postoperative rehabilitation for ankle fractures.<\/jats:p>","DOI":"10.3390\/s25030825","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T04:01:39Z","timestamp":1738209699000},"page":"825","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biofeedback\u2019s Effect on Orthosis Use: Insights from Continuous Six-Week Monitoring of Ankle Fracture Loading"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-4465","authenticated-orcid":false,"given":"Tobias Peter","family":"Merkle","sequence":"first","affiliation":[{"name":"Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Knop","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-518X","authenticated-orcid":false,"given":"Tomas","family":"Da Silva","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Orthopaedics, Klinikum Stuttgart-Katharinenhospital, 70174 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1016\/S0020-1383(15)30018-8","article-title":"Analysis of 213 currently used rehabilitation protocols in foot and ankle fractures","volume":"46","author":"Pfeifer","year":"2015","journal-title":"Injury"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Castellarin, G., Merlini, M., Bettinelli, G., Riso, R., Bori, E., and Innocenti, B. (2022). Effect of an Innovative Biofeedback Insole on Patient Rehabilitation after Total Knee Arthroplasty. Appl. Sci., 12.","DOI":"10.3390\/app12052456"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"North, K., Kubiak, E.N., Hitchcock, R.W., and Petelenz, T.J. (2013, January 3\u20137). Load Monitoring System for Partial Weight Bearing Therapy for rehabilitation of lower extremity fractures. Proceedings of the 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Osaka, Japan.","DOI":"10.1109\/EMBC.2013.6609460"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Warmerdam, E., Wolff, C., Orth, M., Pohlemann, T., and Ganse, B. (2024). Long-term continuous instrumented insole-based gait analyses in daily life have advantages over longitudinal gait analyses in the lab to monitor healing of tibial fractures. Front. Bioeng. Biotechnol., 12.","DOI":"10.3389\/fbioe.2024.1355254"},{"key":"ref_5","unstructured":"Wagner, W.R., Sakiyama-Elbert, S.E., Zhang, G., and Yaszemski, M.J. (2020). 2.1.6\u2014Effects of Mechanical Forces on Cells and Tissues. Biomaterials Science, Academic Press. [4th ed.]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1177\/1938640018769740","article-title":"Incidence of and Risk Factors for Venous Thromboembolism After Foot and Ankle Surgery","volume":"12","author":"Huntley","year":"2019","journal-title":"Foot Ankle Spec."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1302\/0301-620X.83B7.0831037","article-title":"The effect of partial and full weight-bearing on venous return in the lower limb","volume":"83","author":"Eisele","year":"2001","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.gaitpost.2004.12.005","article-title":"Partial weight bearing after surgery for fractures of the lower extremity\u2013is it achievable?","volume":"23","author":"Vasarhelyi","year":"2006","journal-title":"Gait Posture"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jagtenberg, E.M., Kalmet, P.H., De Krom, M.A., Blokhuis, T.J., Seelen, H.A., and Poeze, M. (2020). Feasibility and validity of ambulant biofeedback devices to improve weight-bearing compliance in trauma patients with lower extremity fractures: A narrative review. J. Rehabil. Med., 52.","DOI":"10.2340\/16501977-272"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"North, K., Simpson, G., Geiger, W., Cizik, A., Rothberg, D., and Hitchcock, R. (2024). Predicting the Healing of Lower Extremity Fractures Using Wearable Ground Reaction Force Sensors and Machine Learning. Sensors, 24.","DOI":"10.3390\/s24165321"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.fas.2023.04.006","article-title":"Immediate weight bearing without immobilization for operatively treated ankle fractures is safe\u2014A systematic review","volume":"29","author":"Baumbach","year":"2023","journal-title":"Foot Ankle Surg."},{"key":"ref_12","first-page":"E92","article-title":"Biofeedback versus physiotherapy in patients with partial weight-bearing","volume":"37","author":"Hershko","year":"2008","journal-title":"Am. J. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.apmr.2011.11.019","article-title":"Effectiveness of audio feedback for partial weight-bearing in and outside the hospital: A randomized controlled trial","volume":"93","author":"Hurkmans","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1007\/s00264-017-3481-7","article-title":"Weight-bearing recommendations after operative fracture treatment-fact or fiction? Gait results with and feasibility of a dynamic, continuous pedobarography insole","volume":"41","author":"Braun","year":"2017","journal-title":"Int. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.2106\/JBJS.15.01054","article-title":"Patient Compliance with Postoperative Lower-Extremity Non-Weight-Bearing Restrictions","volume":"98","author":"Chiodo","year":"2016","journal-title":"J. Bone Jt. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Merkle, T.P., Hofmann, N., Knop, C., and Da Silva, T. (2024). Is an Ambulatory Biofeedback Device More Effective than Instructing Partial Weight-Bearing Using a Bathroom Scale? Results of a Randomized Controlled Trial with Healthy Subjects. Sensors, 24.","DOI":"10.3390\/s24196443"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3113","DOI":"10.1007\/s00402-024-05406-2","article-title":"Partial weight-bearing following ankle fracture: What\u2019s the actual load in early recovery?","volume":"144","author":"Merkle","year":"2024","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5701","DOI":"10.1007\/s00402-023-04878-y","article-title":"Continuous real-time biofeedback in orthosis improves partial weight bearing on stairs","volume":"143","author":"Merkle","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.ajem.2018.01.008","article-title":"A systematic review of the pain scales in adults: Which to use?","volume":"36","author":"Karcioglu","year":"2018","journal-title":"Am. J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1001\/jama.2018.14854","article-title":"The Physical Activity Guidelines for Americans","volume":"320","author":"Piercy","year":"2018","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/BCO.0000000000000469","article-title":"Longitudinal monitoring of patient limb loading throughout ankle fracture rehabilitation using an insole load monitoring system: A case series","volume":"28","author":"North","year":"2017","journal-title":"Curr. Orthop. Pract."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/3\/825\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:38:38Z","timestamp":1759919918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/25\/3\/825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,30]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["s25030825"],"URL":"https:\/\/doi.org\/10.3390\/s25030825","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2025,1,30]]}}}