The Ankle Recovery Trial (ART): clinical outcomes and patient experience of a pragmatic multicentre RCT comparing cast with removable boot for early mobilization after ankle fracture surgical fixation

Listen to Simon and Amy discuss the paper 'The Ankle Recovery Trial (ART): clinical outcomes and patient experience of a pragmatic multicentre RCT comparing cast with removable boot for early mobilization after ankle fracture surgical fixation' published in the November 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper, 'The Ankle Recovery Trial (ART): clinical outcomes and patient experience of a pragmatic multicentre RCT comparing cast with removable boot for early mobilization after ankle fracture surgical fixation', published in November 2025 by R Martin and colleagues. I'm Simon and I'm Amy.

Simon, this study has some truly fascinating implications for how we manage ankle fracture recovery. It's not every day you come across a multicentre RCT like this one. The main focus of the trial was to compare the functional outcomes and patient experience between cast immobilization and early mobilization in a removable boot after ankle fracture fixation. What's particularly notable is the scale of the study, involving eight NHS hospitals across the UK.

Indeed and the inclusion of both qualitative and economic evaluations is remarkably thorough. They randomized [00:01:00] 243 adults with acute ankle fractures to receive either a plaster cast or a removable support boot two weeks after surgery.

The primary outcome measured was the ankle function using the Olerud and Molander Ankle Symptom Score, OMAS at seven weeks post-surgery.

So the findings are quite intriguing. At seven weeks, they observed a mean difference in OMAS of 4.9 points, favoring the boot. But this was below the minimal clinically important difference and they did not detect a significant difference between the two groups. In essence, both treatments resulted in comparable functional outcomes.

However, they found that boot participants had better dorsiflexion and plantarflexion in certain subgroups. For instance, those with common comminuted fractures and older patients experienced improved mobility with the boot. On the downside, the complication rates were a touch higher in the boot group with 18 out of 117 participants encountering issues compared to eight out of 112 in the cast group.

Most of these were minor except for one case of deep vein thrombosis in the boot [00:02:00] group. That's a salient point, Simon. Another aspect to consider was the overall patient experience. Semi-structured telephone interviews revealed that participants generally preferred the boot, citing increased confidence in walking in greater comfort.

Some found the ability to remove the boot at night, particularly beneficial for their sleep, and let's not overlook that early mobilization, although slightly more prone to minor complications, offers significant psychological benefits. Patients felt more in control and were more engaged in their recovery process with the boot.

Precisely, this study highlights that early weightbearing in either a removable boot or plaster cast following ankle fracture fixation yield similar functional outcomes. Hence, the choice of treatment could be guided by individual patient preference, and specific clinical situations.

To summarize, this trial provides invaluable insights for clinicians. While both treatments are effective, the removable boot may offer better mobility for certain subgroups and a more favorable patient experience overall. However, [00:03:00] the potential for minor complications means that patient education and careful monitoring are crucial.

Absolutely Simon, clinicians should balance the benefits of comfort and patient autonomy against the risks of minor complications. It's all about finding the right balance based on each patient's unique circumstances.

Well put! That wraps up our discussion for today. We hope this episode helps shed light on the latest findings in ankle fracture recovery management. Stay tuned for our next episode of AI Talks with Bone & Joint.

Thank you for listening. Until next time.