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The purpose of this study was to evaluate metabolic energy cost and external mechanical work for step-tot-step transitions during level walking after tibiotalar arthrodesis and to examine if curve-shaped shoes reduce external mechanical work and metabolic energy cost of level walking. Oxygen uptake, forceplate data and kinematic data were recorded in 18 controls and 15 patients while walking at a fixed speed of 1.25m/s. Subjects were offered three walking conditions: barefoot, normal walking shoes and curve-shaped shoes. The results showed that patients with a tibiotalar arthrodesis had a 11.8% higher metabolic energy cost. During step-to-step transitions positive work during push-off with the fused ankle was decreased but negative work during collision of the unaffected leading leg was not increased. Total absolute external mechanical work over a complete stride was not different between groups and therefore could not explain the increased metabolic energy cost in patients. Both in patients and controls curve-shaped shoes led to decreased push-off and increased collision and higher metabolic energy cost. From the results it was concluded that metabolic energy cost increases after ankle arthrodesis, but external mechanical work for step-to-step transitions cannot account for this increase. Curve-shaped shoes did not reduce metabolic energy cost of walking.
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