Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 30, 2026
Date Accepted: Jul 20, 2026
Timed-up-and-go test using instrumented insoles to monitor tibial or malleolar fracture healing in patients with healing fractures or nonunion: longitudinal and cross-sectional exploratory study
ABSTRACT
Background:
The timed-up-and-go (TUG) test is a mobility-related task commonly performed in clinical practice for a variety of clinical applications. By instrumenting the TUG test with sensors, additional parameters can be extracted, that may add clinical value. Instrumented insoles are among the most promising wearable devices that are currently being explored for clinical purposes.
Objective:
To assess additional parameters obtained by instrumenting the TUG test with pressure sensing insoles to monitor fracture healing, and to analyse if these parameters reveal differences between patients with and without union of tibial or malleolar fractures.
Methods:
Patients with tibial or malleolar fractures and matched controls were enrolled. Patient TUG test data were collected as follows: 1. Longitudinally; six weeks, three months, and six months after surgery, or 2. Cross-sectionally; six months after surgery when patients were referred for nonunion treatment. All participants performed the TUG test with instrumented insoles. TUG tests were video-recorded and analysed in terms of the time taken to complete each part of the TUG test. The insole data-derived outcome measures were maximal force during sit-to-stand and stand-to-sit movements, stance time and stride time during walking, and asymmetry of the previously mentioned parameters.
Results:
Twenty-seven fracture patients, a similar number of healthy adults, and 9 nonunion patients were assessed. All TUG parameters improved throughout the healing process (all P<.001). The greatest improvements were detected between six weeks and three months (all P<.001). Among the classical TUG parameters, between three and six months, only the total TUG time, walking time, stand-to-sit time and total number of steps significantly improved (P=.004, P=.013, P=.028, P=.002). Based on the additional measures, six months after surgery, the loading of the injured side was reduced in patients compared with healthy controls during sit-to-stand and stand-to-sit movements (P<.001). Six months after surgery, patients with fracture nonunion had significantly poorer performance in terms of all the TUG test parameters, except for stance time, than patients with union.
Conclusions:
The instrumented TUG test offers additional parameters to monitor healing of tibial and malleolar fractures. It may assist in the early identification of patients with nonunion. Clinical Trial: German Clinical Trials Registry DRKS00025108; https://drks.de/search/en/trial/DRKS00025108
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