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

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.

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Elizabeth Cody ◽  
Carol Mancuso ◽  
Jayme Burket ◽  
Anca Marinescu ◽  
Aoife MacMahon ◽  
...  

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.


2017 ◽  
Vol 38 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Carol A. Mancuso ◽  
Jayme C. Burket ◽  
Anca Marinescu ◽  
Aoife MacMahon ◽  
...  

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.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Jensen K. Henry ◽  
Andrew R. Roney ◽  
Amelia Hummel ◽  
Elizabeth Cody ◽  
Carol A. Mancuso ◽  
...  

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.


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

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.


2019 ◽  
Vol 13 (6) ◽  
pp. 451-462 ◽  
Author(s):  
Leif Claassen ◽  
Daiwei Yao ◽  
Sarah Ettinger ◽  
Matthias Lerch ◽  
Kiriakos Daniilidis ◽  
...  

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


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Eric C. Gokcen ◽  
Joshua C. Luginbuhl ◽  
Joshua C. Luginbuhl

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.


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

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.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Brian T. Sleasman ◽  
Alexander Caughman ◽  
Christopher E. Gross

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.


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Malik Siddique ◽  
Jayasree Ramaskandhan ◽  
Sultan Qasim

Category: Midfoot/Forefoot Introduction/Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Hallux Valgus and Hallux Rigidus. We aimed to compare foot specific patient reported disability and general health status including higher functional activities and quality of life reported between patients presenting with Hallux Valgus and Hallux Rigidus. Methods: All patients who presented at our hospital foot and ankle clinics (between June 2016 and December 2017) with a diagnosis of primary Hallux Valgus or Hallux Rigidus were included in this prospective study. Patients with associated foot problems, bilateral presentations, h/o previous reconstructive surgeries, and underlying neurological conditions were excluded. These patients were grouped based on diagnosis into Group A (Hallux Valgus) and Group B (Hallux Rigidus). In these patients, differences were studied between groups for scores of MOX-FQ Manchester-Oxford foot questionnaire (Domains: Pain, Walking/Standing, Social activities), EQ-5D EuroQol (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, Recreation, Quality of Life). Statistical tests between groups included tests for normality, student t’tests and chi square tabulation tests using SPSS software. Results: MOX-FQ differences: -  Both groups reported similar level of pain (59.6 ± 22.6 vs. 58.2 ± 23.3); p=0.776; Difficulty with walking/ standing (61.6 vs. 61.4 ); p= 0.960; and restriction with social activity because of foot symptoms (61.6 vs. 59.7 ); p=0.683 EQ-5D: -  For mobility, both groups reported no (21.7% vs. 26.8); slight (28.2% vs. 29.2%) or moderate (34.7% vs. 31.7%) problems; p=0.931. For self-care, pain/discomfort, anxiety/ depression levels, there was no differences between groups; p>0.05. Mean overall general health scores was (71.3 ± 22.8) and (69.5 ± 20.8); p=0.663 FAOS: -  There was no difference in mean pain score (59.6 vs. 58.2; p=0.776), symptoms (70.3 vs. 63.8; p=0.104), ADL score (p=0.587), difficulty with sport/ recreation (p=0.907) or Quality of Life (p=0.662) between groups Conclusion: -  There is no difference in foot related quality of life, general health status and higher functional disability levels between patients presenting with Hallux Valgus vs. Hallux Rigidus. -  The impact of these conditions on disability levels remain the same, amidst the difference in pathology


2021 ◽  
Vol 15 (3) ◽  
pp. 191-192
Author(s):  
Ramón Viladot-Pericé ◽  
Antonio Viladot Voegeli

Hallux rigidus (HR) represents one of the most frequent forefoot disorders, together with hallux valgus and lateral toe deformities, being the most frequent degenerative process in the foot and ankle.This publication is the result of the collaboration of colleagues of the Spanish Society of Medicine and Foot and Ankle Surgery (Sociedad Española de Medicina y Cirugía del Pie y Tobillo, SEMCPT) and the Argentinean Society of Medicine and Foot and Leg Surgery (Sociedad Argentina de Medicina y Cirugía de Pie y Pierna, SAMCPP). It is an honor for us to have this work edited in the Journal of the Foot & Ankle, a journal with a marked Latin identity. We really thank Alexandre Leme Godoy-Santos, Chairman of the Editorial Board, for his help and contribution. This update topic has been coordinated by R. Viladot Pericé and A. Viladot Voegeli, together with M. Herrera and M. Núñez-Samper.Considering the interest and the extent of this topic and, according to the coordinators, we have divided the publication into two parts. The first one describes general aspects (definition, etiology, classification, treatment algorithm, etc.) and the conservative treatment of HR, whereas the second one addresses the different surgical techniques described to treat this disease.The aim of this work is to review our knowledge on HR and to perform an update on the innovations that have emerged during the last years.


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