scholarly journals Patients’ Expectations from Foot and Ankle Surgery

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Elizabeth Cody ◽  
Carol Mancuso ◽  
Jayme Burket ◽  
Anca Marinescu ◽  
Aoife MacMahon ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Short Form ◽  
Osteochondral Lesion ◽  
Assistive Device ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Health ◽  
Preoperative Expectations

Category: Other Introduction/Purpose: Few authors have investigated patients’ expectations from foot and ankle surgery, and standardized means of assessing expectations are lacking. Managing patients’ preoperative expectations may help improve their ultimate satisfaction with surgery. In a previous study (in press), we developed a valid and reliable patient-derived expectations survey for patients undergoing 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 one of six orthopaedic foot and ankle surgeons were screened for inclusion over eight months. Preoperatively, patients completed the 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 contains 23 expectations categories, each with five answer choices ranging from I do not have this expectation to complete improvement expected. It is scored from 0-100; higher scores indicate greater expectations. Differences in expectations score with categorical variables were assessed with t-tests and single factor analysis of variance (ANOVA). Differences in number of expectations and number of expectations with complete improvement expected were assessed with Mann-Whitney U and Kruskal Wallis tests. Relationships between expectations and continuous variables were assessed with linear regression. Results: 352 patients (average age 55 ± 15, range 18 to 86) were enrolled. Expectations were not significantly related to age. Women expected to achieve complete improvement more often than men (p = 0.011). Other factors significantly associated with higher expectations (p < 0.05) included non-Caucasian race, workers’ compensation, use of a cane or other assistive device, diagnosis of ankle instability or osteochondral lesion, and greater medical comorbidity (Table). Patients with a history of prior orthopaedic surgery were less likely to expect complete improvement. Worse function and quality of life (as assessed by all FAOS subscales and 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 < 0.001 for all). Conclusion: 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.

scholarly journals Patients’ Expectations of Foot and Ankle Surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Scott Ellis ◽  
Elizabeth Cody ◽  
Jayme Koltsov ◽  
Anca Marinescu ◽  
Carol Mancuso
Keyword(s):  
Hallux Valgus ◽  
Ankle Instability ◽  
Short Form ◽  
Osteochondral Lesion ◽  
Hallux Rigidus ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Patient Health ◽  
Pain Visual Analog Scale ◽  
Item Scale

Category: Patient expectations Introduction/Purpose: Patients’ expectations from orthopaedic surgery may strongly affect postoperative satisfaction and have been shown to relate to many different factors, including age, sex, functional status, and health. However, the diverse diagnoses in foot and ankle surgery may also influence expectations. While pain relief tends to be the predominant expectation of orthopaedic foot and ankle patients, there are certain expectations that may be more important for patients with certain diagnoses. In this study, we aimed to analyze differences in patients’ expectations among the major surgical diagnoses seen in foot and ankle practices. Methods: 352 patients undergoing elective foot and ankle surgery by six orthopaedic foot and ankle surgeons were enrolled over eight months. Patients completed the Foot & Ankle Surgery Expectations Survey preoperatively, as well as 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 is scored from 0-100 with higher scores indicating greater expectations. Each of its 23 items can also be assessed independently. Differences in expectations scores between diagnoses were analyzed with t-tests and analysis of variance (ANOVA). Differences in the number of expectations and number of expectations with complete improvement expected were analyzed with Mann-Whitney U and Kruskal Wallis tests. Results: Patients with a diagnosis of ankle instability or osteochondral lesion (OCL) had higher expectations scores (p = 0.004) and more often expected complete improvement (p = 0.024) compared to patients with other diagnoses (Table). Patients with hallux valgus had lower expectations scores (p = 0.005) than patients with other diagnoses. Patients with mid- or hindfoot arthritis also had lower expectations scores (p = 0.006) and even more significantly, had an average of only 2.4 expectations with complete improvement expected, while all other patients averaged 8.4 (p < 0.001). Expectations that were relatively unique to specific diagnoses included increased shoe variety for hallux valgus and hallux rigidus, improved appearance for hallux valgus, and improved ability to run for exercise for ankle instability or OCL. Conclusion: Patients’ expectations of foot and ankle surgery vary widely by diagnosis. Higher expectations among patients with ankle instability/OCL may be related to worse functional and mental health status (Table). Lower expectations among patients with hallux valgus and mid- or hindfoot arthritis may be attributable in part to patients’ recognition of the difficulty of treating their condition. Preoperative counseling by their surgeons regarding realistic expectations may also be a factor. We can use the findings of this study to predict what expectations are most important to patients with different diagnoses and to guide how we counsel them prior to surgery.

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.

Influence of Diagnosis and Other Factors on Patients’ Expectations of Foot and Ankle Surgery

2018 ◽  
Vol 39 (6) ◽  
pp. 641-648 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Huong T. Do ◽  
Jayme C. B. Koltsov ◽  
Carol A. Mancuso ◽  
Scott J. Ellis
Keyword(s):  
Multivariate Regression ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Multivariate Regression Analysis ◽  
Foot And Ankle ◽  
Patient Factors ◽  
Outcome Score ◽  
Caucasian Race ◽  
Ankle Surgery ◽  
Preoperative Expectations

Background: Many patient factors have been associated with higher or lower expectations of orthopedic surgery. In foot and ankle surgery, the diverse diagnoses seen may also influence expectations. The aim of this study was to investigate the relationship between diagnosis and patients’ preoperative expectations of elective foot and ankle surgery. Methods: Two hundred seventy-eight patients undergoing elective foot or ankle surgery for 1 of 7 common diagnoses were enrolled in a prospective cohort study. Preoperative expectations were assessed with the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed the Foot & Ankle Outcome Score, Short Form 12, pain visual analog scale, and questionnaires for depressive and anxiety symptoms. Demographic and clinical data were collected. Patient factors and diagnosis were analyzed using multivariate regression analysis to identify independent predictors of higher expectations and determine the effect of diagnosis relative to other patient factors on expectations. Results: The multivariate regression analysis adjusting for demographics and other clinical characteristics showed that diagnosis contributed the most to the model, accounting for 10.5% of the variation in expectations survey scores. Patients with mid- or hindfoot arthritis ( P < .001), hallux valgus ( P = .001), or hallux rigidus ( P = .005) had lower scores (lower expectations) than those with ankle instability or osteochondral lesion. In the model, female sex ( P = .001), non-Caucasian race ( P = .031), and lower scores on the Foot & Ankle Outcome Score daily activities subscale ( P = .024) were associated with higher scores. Conclusions: Diagnosis of ankle instability or osteochondral lesion, female sex, non-Caucasian race, and lower Foot & Ankle Outcome Score daily activities subscale score were all associated with higher expectations. These findings may help inform and guide surgeons as they counsel patients preoperatively. Level of Evidence: Level II, cross-sectional study.

scholarly journals Incidence of Venous Thromboembolism in Orthopaedic Foot and Ankle Surgeries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Ashish Shah ◽  
Samuel Huntley ◽  
Harshadkumar Patel ◽  
Eildar Abyar ◽  
Eva Lehtonen ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Improvement Program ◽  
Female Sex ◽  
Increased Risk ◽  
Ankle Surgery

Category: Other Introduction/Purpose: Venous thromboembolism (VTE) is a rare but potentially lethal complication following orthopaedic foot and ankle surgery. Surgeons continue to debate the types of patients and procedures in which it is appropriate to use chemical thromboprophylaxis. A recent meta-analysis concluded that patients at high risk for VTE after foot and ankle surgery should receive prophylaxis, but there remains a paucity of data to elucidate which demographic or comorbidity variables are most strongly associated with development of VTE. The incidence of VTE after orthopaedic foot and ankle surgery stratified by specific procedure has yet to be examined. The purpose of this study is to report the incidence of and identify risk factors for VTE in a large sample of patients receiving orthopaedic foot and ankle surgery. Methods: In this study, we retrospectively analyzed prospectively-collected data from the National Surgical Quality Improvement Program (NSQIP) 2006 to 2015 data files. The incidence of VTE was calculated for 30 specific orthopaedic foot and ankle surgeries and for four broad types of foot and ankle surgery. A total of 23,212 patients were identified and grouped by current procedures terminology (CPT) codes. Demographic, comorbidity, and complication variables were analyzed to determine associations with development of VTE. Pearson’s chi-squared test was used to compare categorical variables and Student t test was used to compare continuous variables. P-values of p<0.05 were considered statistically significant. Multivariable modelling was not possible due to the very low number of VTE cases relative to non-VTE cases. Results: The mean age at the time of surgery was 52.7±17.8 years. VTE events were documented 142 times in our sample, yielding an overall sample VTE incidence of 0.6%. The types of procedures with the highest frequency of VTE were ankle fractures (105/15,302 cases, 0.7%), foot pathologies (28/5,466, 0.6%), and arthroscopy (2/398, 0.5%). Female sex, increasing age, obesity level, inpatient status, and non-elective surgery were all significantly associated with VTE events. Postoperative pneumonia was significantly associated with VTE development. Patients who developed a VTE stayed at the hospital after surgery significantly longer than patients without VTE (6.2 vs. 3.1 days). Patients who developed VTE also had significantly higher estimated probability of morbidity (8.0% vs. 6.0%) and mortality (2.0% vs. 1.0%) when compared to patients without VTE. Conclusion: The present study confirms that VTE events after foot and ankle procedures are rare. The data presented suggest that female sex, increasing age, higher BMI, inpatient status, and non-elective procedures are associated with increased risk for VTE after orthopaedic foot and ankle surgery. Prospective, randomized, controlled trials are necessary to definitively determine the efficacy of chemoprophylaxis and to develop evidence-based clinical practice guidelines to minimize VTE after foot and ankle procedures.

scholarly journals Safety and Outcomes of Inpatient Compared with Outpatient Procedures for Elective Orthopaedic Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042
Author(s):  
Ashish Shah ◽  
Samuel Huntley ◽  
Harshadkumar Patel ◽  
Sameer Naranje ◽  
Sung Lee ◽  
...  
Keyword(s):  
Ankle Fractures ◽  
National Database ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Improvement Program ◽  
Outpatient Procedures ◽  
Ankle Surgery ◽  
Transmetatarsal Amputation ◽  
Tract Infections

Category: Ankle Introduction/Purpose: With increasing implementation of the bundled payment model and meteoric rise in healthcare prices over the past decade, efforts to minimize unnecessary costs are highly warranted. One potential method to do this is by performing foot and ankle surgery on patients either in an appropriate inpatient or outpatient setting. There is evidence suggesting that outpatient orthopaedic foot and ankle surgery for ankle fractures leads to lower risk of 30-day medical morbidities, reoperation, and admissions as compared to inpatient surgeries. The purpose of this study is to compare the inpatient versus outpatient outcomes of patients undergoing elective orthopaedic foot and ankle surgery using a large national database. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) years 2005-2015 were used in this study. There were 216 CPT codes specific to orthopaedic foot and ankle surgery queried for inclusion in the analysis, 36 of which were identified in the database. CPT codes representing ORIF of ankle fractures were excluded. These codes were manually reviewed by a licensed orthopaedic foot and ankle surgeon to confirm their elective nature, reducing the number of codes to 30. Demographic, comorbidity, and outcome variables were calculated and stratified by inpatient versus outpatient status. Significant differences in these variables were evaluated using ANOVA for continuous variables and Pearson’s Chi-Square for categorical variables. There was a total of 7,672 cases identified. Results: The most common elective inpatient procedures were transmetatarsal amputation (57.9%), total ankle arthroplasty (13.0%), and midtarsal amputation (5.2%). The most common elective outpatient procedures were collateral ligamentous repair (15.8%), transmetatarsal amputation (10.7%), and extensor tendon repair (8.7%). As compared to patients receiving outpatient treatment, patients who received inpatient treatment for elective foot and ankle surgeries were significantly older, male, had lower BMI, and were more likely to smoke. Inpatients were also more likely to receive general anesthesia, have shorter operative times, and have functional limitations (p<0.05). Inpatients were more likely to suffer from various complications, including surgical site infection, pneumonia, unplanned intubation, renal insufficiency, acute renal failure, urinary tract infections, myocardial infarction, cardiac arrest, stroke, transfusions, sepsis, and reoperation (p<0.05). Conclusion: Our results show that outpatient procedures for elective foot and ankle surgery were significantly safer than inpatient procedures in regard to complication profiles. However, the inpatients who received surgery were significantly older than the outpatients, which may explain the described findings. Additional advanced regression modeling is currently underway to examine the multivariable associations between inpatient status and total hospital costs.

scholarly journals Postoperative infection in foot & ankle surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042
Author(s):  
Ashish Shah ◽  
Samuel Huntley ◽  
Eildar Abyar ◽  
Eva Lehtonen ◽  
Sameer Naranje ◽  
...  
Keyword(s):  
Surgical Site Infections ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Improvement Program ◽  
Chi Square ◽  
Surgical Incision ◽  
Prosthetic Implants ◽  
Ankle Surgery ◽  
Orthopaedic Literature

Category: Other Introduction/Purpose: Surgical site infections (SSI) are infections of the incision site, organ, or space at or near the surgical incision within 30 days of the procedure or within 90 days for prosthetic implants. Being the most common nosocomial infection, SSI’s are a burden to the healthcare system as they increase costs, duration of stay, antimicrobial resistance, morbidity, and mortality. While there is limited evidence in the orthopaedic literature suggesting that the incidence of SSI increases during the summer months, this association has not been examined in the setting of foot and ankle surgery. The purpose of this study was to determine whether seasonal variation plays a role in developing SSI’s after orthopaedic foot and ankle surgery. Methods: Data from the National Surgical Quality Improvement Program (NSQIP) years 2011-2015 were used in this study. The pooled and individual incidences of superficial incisional SSI, deep SSI, and organ space SSI were calculated and stratified by quarter of admission. The quarters of admission represent the various seasons (1=winter, 2=spring, 3=summer, 4=fall). Differences in the incidence of SSI as well as various demographic, comorbidity, and complication variables were evaluated using ANOVA for continuous variables and Pearson’s Chi-Square for categorical variables. Results: A total of 17,939 patients were identified. After pooling the superficial, deep, and organ space infections, the overall SSI rate was highest in the summer months (July-September, 3rd quarter) at 2.68% as compared to 2.20%, 2.33%, and 2.14% in the other respective quarters (p=0.338). There was a total of 218 cases of superficial incisional SSI. The summer months had the highest incidence of superficial SSI at 1.38% compared to 1.14%, 1.13%, and 1.21% for 1st, 2nd, and 4th quarters, respectively (p=0.677). There were 145 cases of deep incisional SSI. The third quarter again had the highest rate at 1.02% compared to 0.72%, 0.93%, and 0.60% for 1st, 2nd, and 4th quarter respectively (p=0.105). Conclusion: Our results show that superficial incisional SSI, deep incisional SSI, and open wound infections have increased likelihood during the summer months in the setting of orthopaedic foot and ankle surgery. Some studies have associated the increased temperature and humidity during the summer months with increased rates of infections and our results show similar trends. Additional evidence with larger sample sizes is needed to determine which specific procedures are at highest risk of infection during the summer months.

scholarly journals Great Expectations: Predicting Postoperative Expectation Fulfillment in Orthopaedic Foot & Ankle Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Jensen K. Henry ◽  
Andrew R. Roney ◽  
Amelia Hummel ◽  
Elizabeth Cody ◽  
Carol A. Mancuso ◽  
...  
Keyword(s):  
Short Form ◽  
Tendon Injury ◽  
Hallux Rigidus ◽  
Foot And Ankle ◽  
Postoperative Function ◽  
High Expectations ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Preoperative Expectations ◽  
The Relationship

Category: Other Introduction/Purpose: In foot and ankle surgery, the fulfillment of patients’ preoperative expectations is a unique and validated method to assess postoperative success. Expectation fulfillment is closely associated with postoperative outcomes, satisfaction, and patient-reported improvement. Ideally, foot and ankle patients should have realistic expectations of surgery so that they are appropriately prepared for their postoperative symptoms and function. Inappropriately high expectations may predispose to worse outcomes because patients have unrealistic views about what their surgery can actually accomplish. Conversely, inappropriately low expectations may represent a lack of motivation to improve or participate in rehabilitation and postoperative protocols. This study aimed to identify the relationship between preoperative expectations and postoperative fulfillment. These results may facilitate surgeon-patient communication and help patients prepare for their operation and their postoperative function. Methods: Adult patients undergoing elective foot and ankle surgery at a single center were prospectively enrolled. Demographics, diagnosis, and outcomes surveys (Short Form [SF]-12, Foot & Ankle Outcome Score, improvement, satisfaction) were collected. Preoperatively, each patient completed the Expectations Survey (range 0-100, with 100 indicating maximum expectations), which asks about anticipated improvement in domains like pain, ambulation, function, and shoewear. Two years after surgery, for each expectation cited preoperatively, patients answered how much improvement they actually achieved. Using a ratio of the postoperative and preoperative scores, a Fulfillment Proportion (FP) was calculated, along with the minimal clinically important difference (MCID). This permitted identification of patients with unfulfilled, fulfilled, and surpassed expectations. Bivariate correlations, chi-square analyses, and multivariate regressions with 95% confidence intervals (CI) were performed to identify the relationship between preoperative expectations, clinical variables, and postoperative expectation fulfillment. Results: There were 271/340 (80%) patients with 2-year follow-up, with mean age 55.4 years and 65% female. Most common diagnoses were hallux valgus (25%), flatfoot (11%), hallux rigidus (11%), ankle arthritis (10%), and chronic tendon injury (9%). Expectation fulfillment differed significantly with extent of preoperative expectations (Figure). Patients with average/high expectations had higher rates of unfulfillment compared to patients with low preoperative expectations (40-41% vs. 22%). Rates of surpassed expectations were highest in patients with low preoperative expectations (23%) compared to average (12%) or high (0%) preoperative expectations (p<.001). In multivariate regression, the greatest predictor of postoperative FP was the preoperative expectations score (p<.001), and lower preoperative expectations conferred a 3.2x (95% CI 1.6-6.2) greater likelihood of more expectations fulfilled (p=.001). Conclusion: Preoperative expectations were a significant predictor of expectation fulfillment after foot and ankle surgery. Lower preoperative expectations were associated with fulfilled or surpassed expectations after surgery, whereas high preoperative expectations were significantly more likely to be unmet. These findings may help guide whether patients’ expectations are realistic or inappropriate preoperatively. It is imperative for surgeons to consider and discuss patients’ expectations prior to surgery to ensure they have an appropriate understanding of their potential outcome. Further research should be directed to the extent that patients’ preoperative expectations can be modified in order to maximize postoperative satisfaction.

Relevance of SPECT-CT in Complex Cases of Foot and Ankle Surgery: A Comparison With MRI

2019 ◽  
Vol 13 (6) ◽  
pp. 451-462 ◽  
Author(s):  
Leif Claassen ◽  
Daiwei Yao ◽  
Sarah Ettinger ◽  
Matthias Lerch ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Osteochondral Lesion ◽  
Treatment Decision ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Intrarater Reliability ◽  
Final Treatment ◽  
Adjacent Structures ◽  
Ankle Surgery

Background. Finding the right diagnoses in patients with complex foot and ankle disorders can be challenging. Single-photon emission computed tomography and computed tomography (SPECT-CT) has shown to be feasible in foot and ankle surgery. The aim of this study was to evaluate the reliability and accuracy of SPECT-CT and thereby its impact on final treatment decision compared with magnetic resonance imaging (MRI). Methods. A retrospective study was performed on 49 patients treated at our institution. Experienced foot and ankle surgeons independently, and blinded, analyzed clinical data and radiographs together with MRI, SPECT-CT, or a combination of both. Based on the determined final treatment decision Cohen’s kappa values were calculated to illustrate interrater and intrarater reliability. Results. The kappa values for interrater reliability were higher for SPECT-CT at .68 and MRI + SPECT-CT at .71 compared to 0.38 for MRI alone (P < .05). The kappa values for intrarater reliability of MRI + SPECT-CT were higher at .75 compared with SPECT-CT alone at .67 (P < .05) and MRI at .35 (P < .01). Conclusion. We found a higher interrater and intrarater reliability for SPECT-CT compared with MRI alone for diagnosing complex foot and ankle pathologies. SPECT-CT has a high impact on final treatment decision. The main indications are bony pathologies with diagnostic uncertainty especially in closely adjacent structures as the joints of the midfoot, occult coalitio, stress fractures, verification or exclusion of nonfusion, periprosthetic disorders after total ankle replacement and osteochondral lesion in cases of combined pathologies. Levels of Evidence: Level IV: Retrospective study

scholarly journals The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl
Keyword(s):  
Orthopaedic Surgery ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Perceived Effectiveness ◽  
Educational Impact ◽  
Short Term ◽  
Surgical Mission ◽  
Ankle Surgery ◽  
Orthopaedic Residency ◽  
The Impact

Category: Other Introduction/Purpose: Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips. Methods: A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology. Results: When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75. Conclusion: The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

scholarly journals Validation of the Indonesian version of the foot and ankle score in patients with chronic lateral ankle instability

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
I Putu Gde Surya Adhitya ◽  
Wen-Yu Yu ◽  
Putu Ayu Sita Saraswati ◽  
I Made Niko Winaya ◽  
Mau-Roung Lin
Keyword(s):  
Rating Scale ◽  
Ankle Instability ◽  
Short Form ◽  
Correlation Coefficients ◽  
Principal Component ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Sf 36 ◽  
Lateral Ankle Instability

Abstract Background This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI). Methods The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1-year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS), and Short Form (SF)-36 were used to test the construct validities. Results The five subscales indicated adequate internal consistency (Cronbach’s alpha, 0.74 ~ 0.96) and interrater test-retest reliabilities (interclass correlation coefficients, 0.80 ~ 0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs ($$r$$ r values, 0.32 ~ 0.53), with the exception of the correlation of pain with the NPRS ($$r$$ r , -0.06). Results of the principal component analysis showed that the five-factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt’s responsiveness index for the FAOS’s subscales changed in the SF-36’s physical function over a 1-month period and ranged 0.37 to 1.27. Conclusions The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.

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