Rehabilitation outcomes in patients with complex regional pain syndrome of the ankle-foot complex: a single-center observational study

BMC Musculoskelet Disord. 2026 Jul 2. doi: 10.1186/s12891-026-10154-y. Online ahead of print.

ABSTRACT

BACKGROUND: Complex regional pain syndrome is a debilitating condition that often involves an injury or surgery, leading to chronic pain, swelling, and functional impairment in affected limbs, particularly in the ankle-foot complex. The management is challenging, as patients may experience prolonged symptoms that impact mobility and quality of life. While rehabilitation interventions aim to improve functional outcomes, their effectiveness in restoring full ankle function and mitigating long-term effects varies widely among patients. The purpose of this study was to evaluate the changes in functional recovery during a structured rehabilitation program in patients with complex regional pain syndrome of the ankle-foot complex following trauma. This study was designed as an observational study. Seventy-two patients presented with ankle-foot trauma, 23 of whom were diagnosed with CRPS.

METHODS: Patients underwent a comprehensive rehabilitation program including kinesitherapy, cryotherapy, therapeutic massage, and electrotherapy. Functional recovery was assessed via goniometry, the symmetry index via the G-WALK inertial sensor, locomotor activity tests activities of daily life scoring and pain intensity assessment. Data were analyzed using SPSS.

RESULTS: Statistical analysis of the 23 patients with complex regional pain syndrome revealed statistically significant changes over three rehabilitation courses within five months. Initial assessments revealed hypotrophy of the thigh (2.5 cm) and lower leg muscles (1.5 cm), alongside swelling in the ankle joint (3.5 cm) and foot (2 cm). By the end of the rehabilitation period, hypotrophy decreased to 1 cm in the thigh and 1.5 cm in the calf, with swelling reduced to 1.5 cm in the ankle and 1 cm in the foot. Range of motion improved significantly, with dorsiflexion increasing by 10.83º and plantarflexion by 33.33º. The symmetry index improved from 64.88% to 80.8%, indicating partial restoration of gait symmetry. Pain levels decreased from an average of 15 (severe) to 7.5 (moderate), indicating a reduction in symptom severity over time.

CONCLUSION: Complex regional pain syndrome following ankle-foot trauma requires a tailored rehabilitation program to restore mobility and functionality. While complete gait normalization may be prolonged, improvements in daily activity performance were observed during the rehabilitation period. However, due to the observational design and absence of a control group, causality cannot be established. Further controlled studies are needed to confirm these findings.

PMID:42387478 | DOI:10.1186/s12891-026-10154-y