Abstract
<title>Abstract</title> <p>Unilateral comminuted intra-articular calcaneal fractures involving both the medial and lateral walls of the calcaneus represent challenging injuries. Postoperative rehabilitation may be complicated by persistent gait abnormalities and limited access to objective outcome assessment. A 28-year-old woman sustained a unilateral comminuted intra-articular fracture of the right calcaneus following a fall from height and underwent open reduction and internal fixation (ORIF). She was referred for physiotherapy eight months after surgery with severe antalgic gait, absent heel strike, reduced weight-bearing on the affected limb because of pain, pain localized to the lateral surgical incision with keloid formation, mild swelling, and inability to perform daily prayer prostration because of pain and keloid-related scar tightness. Initial examination demonstrated mild swelling, a well-healed lateral surgical incision with keloid formation, mild tibialis anterior atrophy, pes planus, and a positive pelvic drop during single-leg stance. Manual muscle testing demonstrated ankle dorsiflexion grade 3+, plantarflexion grade 3, and eversion grade 3. Inversion strength could not be reliably assessed because of pain associated with keloid-related scar tightness. The patient completed only 7 to 10 supported heel raises and was unable to maintain single-leg stance. Walking tolerance was limited to less than five minutes. Smartphone-based gait analysis using MediaPipe BlazePose was performed on Day 1, Day 69, Day 81, and Day 108. By Day 69, mean knee angle improved from 161.3° to 145.0°, mean hip angle decreased from 158.3° to 139.7°, and heel strike was completely restored. By Day 81, the patient had returned to independent running, with pelvic drop of 0.003, trunk sway of 0.008, and shoulder tilt of 0.004. At Day 108 follow-up, gait symmetry metrics remained improved and stable, and additional multi-view kinematic analysis showed consistent heel strike patterns and coordinated lower-limb trajectories. This case illustrates substantial functional recovery following structured physiotherapy initiated eight months after ORIF. Smartphone-based MediaPipe gait analysis was feasible for longitudinal monitoring of gait recovery in this single case.</p>