scholarly journals Increasing consensus on terminology of Achilles tendon-related disorders

2021 ◽  
Author(s):  
K. T. M. Opdam ◽  
◽  
R. Zwiers ◽  
J. I. Wiegerinck ◽  
C. N. van Dijk
Keyword(s):  
Achilles Tendon ◽  
Literature Search ◽  
Daily Practice ◽  
Clinical Findings ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Orthopedic Surgeons ◽  
Anatomic Location ◽  
Ankle Surgery ◽  
Current Terminology

Abstract Purpose Aims of this study are to evaluate the current terminology and assess the influence of the latest proposals on the terminology used for Achilles tendon-related disorders in both daily practice and literature. Methods (1) All orthopedic surgeons experienced in the field of foot and ankle surgery of the Ankleplatform Study Group were invited to participate in this survey by email. They were requested to fill out a survey on terminology in six typical cases with Achilles tendon-related disorders. (2) A systematic literature search of Achilles tendon-related disorders was performed in eight foot and ankle journals in Medline, Embase (Classic) from 2000 to 2016. All extracted terms were counted and compared to the terminology proposals, based on anatomic location, symptoms, clinical findings and histopathology. Results (1) In total, 141 of the 283 (50%) orthopedic surgeons responded to the survey. In five out of six cases with Achilles tendon-related disorders, the majority gave an answer according to latest proposals. (2) An overview of terminology used for Achilles tendon-related disorders from 2000 to 2016 shows an increase in use of terminology according to the latest proposals based on anatomic location, symptoms, clinical findings and histopathology. Conclusion The revised terminology for Achilles tendon-related disorders based on anatomic location, symptoms, clinical findings and histopathology is used by the majority of orthopedic surgeons and is increasingly used in the literature. However, the indistinct Haglund eponyms are still frequently used in Achilles tendon-related terminology. Level of evidence Level IV.

Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review

2019 ◽  
Vol 40 (10) ◽  
pp. 1226-1232 ◽  
Author(s):  
Taylor R. Beahrs ◽  
James Reagan ◽  
Clayton C. Bettin ◽  
Benjamin J. Grear ◽  
G. Andrew Murphy ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Basic Science ◽  
Foot And Ankle ◽  
Mineral Density ◽  
Level Of Evidence ◽  
Delayed Fracture ◽  
Current Smoking ◽  
Orthopedic Surgeons ◽  
Ankle Surgery ◽  
Harmful Effects

Background: The purpose of this article was to review the basic science pertaining to the harmful effects of cigarette smoke, summarize recent clinical outcome studies, and examine the benefits of smoking cessation and the efficacy of current smoking cessation strategies. Methods: The literature concerning basic science, clinical outcomes, and smoking cessation was reviewed; over half (56%) of the 52 articles reviewed were published in the last 5 years. Results: Smoking is associated with low bone mineral density, delayed fracture union, peri-implant bone loss, and implant failure. Orthopedic surgical patients who smoke have increased pain and lower overall patient satisfaction, along with significantly increased rates of wound healing complications. Discussion/Conclusion: Active smoking is a significant modifiable risk factor and should be discontinued before foot and ankle surgery whenever possible. Orthopedic surgeons play an important role in educating patients on the effects of smoking and facilitating access to smoking cessation resources. Level of Evidence: Level V, expert opinion.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

Comparison of 2g vs 1 g of Prophylactic Cefazolin in Surgical Site Infections in Trauma Surgery Below the Knee

2020 ◽  
Vol 41 (5) ◽  
pp. 582-589
Author(s):  
Fay R. K. Sanders ◽  
Rosanne M.G. Kistemaker ◽  
Mirjam van ’t Hul ◽  
Tim Schepers
Keyword(s):  
Primary Outcome ◽  
Clinical Effect ◽  
Trauma Surgery ◽  
Surgical Site Infections ◽  
Clinical Results ◽  
Pharmacokinetic Studies ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Below The Knee ◽  
Ankle Surgery

Background: The rate of surgical site infections (SSIs) after foot or ankle surgery remains high, despite the implementation of antibiotic prophylaxis. Recently, guidelines suggest a single dose of 2 g instead of 1 g of cefazolin for implant surgery; this decision is largely based on pharmacokinetic studies. However, the clinical effect of this higher dose has never been investigated in foot and ankle surgery. This retrospective cohort study investigated the effect of 2 g compared with 1 g of prophylactic cefazolin on the incidence of SSIs in foot and ankle surgery. Methods: All patients undergoing trauma-related surgery of the foot, ankle, or lower leg between September 2015 and March 2019 were included. The primary outcome was the incidence of an SSI. SSIs were compared between patients receiving 1 g and 2 g of cefazolin as surgical prophylaxis, using a propensity score to correct for possible confounders. Results: A total of 293 patients received 1 g and 126 patients received 2 g of cefazolin. The overall number of SSIs was 19 (6.5%) in the 1-g group and 6 (4.8%) in the 2-g group. Corrected for possible confounders, this was not statistically significant (OR, 0.770; P = .608). Conclusion: Even though the decrease in SSI rate from 6.5% to 4.8% was found not to be statistically significant, it might be clinically relevant considering the reduction in morbidity, mortality, and healthcare costs. Research linking pharmacokinetic and clinical results of prophylactic cefazolin is needed to establish whether or not the current recommendations and guidelines are sufficient for preventing SSIs in foot and ankle surgery. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0010
Author(s):  
Bradley Alexander ◽  
James Hicks ◽  
Abhinav Agarwal ◽  
Aaradhana J. Jha ◽  
Spaulding F. Solar ◽  
...  
Keyword(s):  
Geographic Origin ◽  
Median Number ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Quality Research ◽  
Level Ii ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Quality Of Research

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text]

Quality of Research and Level of Evidence in Foot and Ankle Publications

2012 ◽  
Vol 33 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Heather L. Barske ◽  
Judith Baumhauer
Keyword(s):  
Clinical Research ◽  
Medical Profession ◽  
Research Articles ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Level I ◽  
Quality Of Research

Background: The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Methods: Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. Results: A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Conclusion: Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

Patient Factors Associated With Higher Expectations From Foot and Ankle Surgery

2017 ◽  
Vol 38 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Carol A. Mancuso ◽  
Jayme C. Burket ◽  
Anca Marinescu ◽  
Aoife MacMahon ◽  
...  
Keyword(s):  
Short Form ◽  
Cross Sectional Study ◽  
Assistive Device ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Ankle Surgery ◽  
Patient Health ◽  
Pain Visual Analog Scale ◽  
Special Surgery

Background: Few authors have investigated patients’ expectations from foot and ankle surgery. In this study, we aimed to examine relationships between patients’ preoperative expectations and their demographic and clinical characteristics. We hypothesized that patients with more disability and those with anxiety or depressive symptoms would have greater expectations. Methods: All adult patients scheduled for elective foot or ankle surgery by 1 of 6 orthopaedic foot and ankle surgeons were screened for inclusion over 8 months. Preoperatively, all patients completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey in addition to the Foot & Ankle Outcome Score (FAOS), Short Form (SF)–12, Patient Health Questionnaire (PHQ)–8, Generalized Anxiety Disorder 7-item scale (GAD-7), and pain visual analog scale (VAS). The expectations survey contained 23 expectations categories, each with 5 answer choices ranging from “I do not have this expectation” to “complete improvement” expected. It was scored from 0 to 100, with higher scores indicating more expectations. Differences in expectations relating to numerous patient demographic and clinical variables were assessed. In total, 352 patients with an average age of 55 ± 15 (range, 18-86) years were enrolled. Results: Expectations scores were not related to age ( P = .36). On average, women expected to achieve complete improvement more often than men ( P = .011). Variables that were significantly associated with higher expectations scores ( P < .05) included nonwhite race, use of a cane or other assistive device, and greater medical comorbidity. Worse function and quality of life (as assessed by all FAOS subscales and the SF-12 physical and mental components), more depressive and anxiety symptoms, and higher pain VAS scores were associated with higher expectations scores and more expectations ( P < .01 for all). Conclusions: The results of this study may help inform surgeons’ preoperative discussions with their patients regarding realistic expectations from surgery. Generally, patients with worse function and more disability had higher expectations from surgery. Addressing these patients’ expectations preoperatively may help improve their ultimate satisfaction with surgery. Level of Evidence: Level II, cross sectional study.

scholarly journals Trends in Foot and Ankle Publications

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian T. Sleasman ◽  
Alexander Caughman ◽  
Christopher E. Gross
Keyword(s):  
Hallux Valgus ◽  
Ankle Fracture ◽  
Current Practice ◽  
Scientific Publication ◽  
Small Subset ◽  
Foot And Ankle ◽  
Primary Method ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Number Of Citations

Category: Ankle; Other Introduction/Purpose: Scientific publication and original articles remain the primary method of sharing scientific findings and thus advancing the knowledge base of that subject. These articles have the potential to reinforce or change current practice. Despite the value of these publications, little research has gone into surveying what topics are being published. Our goal was to identify and characterize the most common topics of publication in current foot and ankle literature. Methods: To determine the rate of publications in the literature, we reviewed all published articles in a 3.5-year period (January 2016 - June 2019) in three foot and ankle specific journals: Foot and Ankle International, Foot and Ankle Orthopaedics, and Foot and Ankle Surgery. We then sorted these articles into the topic of the article to identify the four most common domains of publication. These domains were further characterized by level of evidence as well as citations/year. Results: A total of 845 articles were published in the 3.5-year study period. During this time, the four most published topics in foot and ankle literature were hallux valgus (10%), arthroplasty (9%), ankle fracture (7.5%), and achilles pathology (6.4%). These four subjects accounted for 280/845 articles (33%). The average level of evidence for articles on hallux valgus, arthroplasty, ankle fracture, and Achilles pathology were 3.3 (3.1, 3.4, 3.4, and 3.4 respectively), and the average number of citations/year for these articles was 2.6 (2.3, 3.0, 2.3, and 3.1 respectively). Based on our study there is no correlation between level of evidence and number of citations. Conclusion: Despite the wide variety of cases (176 unique CPT codes) performed by an orthopedically trained foot and ankle surgeons, a small subset of publications represent a significant portion of scientific publication within the field.

Effect of Postoperative Oral Antibiotics on Infections and Wound Healing Following Foot and Ankle Surgery

2020 ◽  
Vol 41 (12) ◽  
pp. 1466-1473
Author(s):  
Jacob Carl ◽  
Trevor J. Shelton ◽  
Kevin Nguyen ◽  
Isabella Leon ◽  
Jeannie Park ◽  
...  
Keyword(s):  
Wound Healing ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Wound Complications ◽  
Oral Antibiotic ◽  
Foot And Ankle ◽  
Oral Antibiotics ◽  
Infection Rates ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified. Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery. Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health. Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries. Level of Evidence: Level III, retrospective comparative series.

Does Revascularization Prior to Foot and Ankle Surgery Reduce the Incidence of Surgical Site Infection (SSI)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 15S-16S
Author(s):  
Nima Heidari ◽  
Alexander Charalambous ◽  
Iris Kwok ◽  
Alexandros Vris ◽  
Yueyang Li
Keyword(s):  
Wound Healing ◽  
Beneficial Effect ◽  
Surgical Site Infection ◽  
Elective Surgery ◽  
Site Infection ◽  
Foot And Ankle ◽  
Peripheral Vascular ◽  
Level Of Evidence ◽  
Diabetic Foot Infection ◽  
Ankle Surgery

Recommendation: Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The majority of studies on revascularization are in the setting of diabetic foot infection or established ischemia. We recommend that in the presence of an inadequate vascularization in the foot and ankle, vascular optimization should be undertaken prior to elective surgery. Level of Evidence: Limited. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Prevalence and Safety of Left-Footed Driving Following Right Foot Surgery Patients Including a Driving Simulation

2019 ◽  
Vol 40 (7) ◽  
pp. 818-825 ◽  
Author(s):  
Haley M. McKissack ◽  
Yvonne E. Chodaba ◽  
Tyler R. Bell ◽  
Eva J. Lehtonen ◽  
Ibukunoluwa B. Araoye ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Recovery Period ◽  
Significant Proportion ◽  
Case Series ◽  
Postoperative Recovery ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
The Right

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

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