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

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]

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

Foot & Ankle International ◽

10.3113/fai.2012.0001 ◽

2012 ◽

Vol 33 (1) ◽

pp. 1-6 ◽

Cited By ~ 19

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.

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Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100720936602 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1173-1180

Author(s):

Aoife MacMahon ◽

Elizabeth A. Cody ◽

Kristin Caolo ◽

Jensen K. Henry ◽

Mark C. Drakos ◽

...

Keyword(s):

Foot And Ankle ◽

Level Of Evidence ◽

Level Ii ◽

Number Of Patients ◽

Ankle Surgery ◽

Minor Surgery ◽

Special Surgery ◽

Individual Surgeon ◽

Prospective Comparative Study ◽

Pain At Rest

Background: Aligning patient and surgeon expectations may improve patient satisfaction and outcomes. This study aimed to assess differences in expectations of foot and ankle surgery between patients and their surgeons. Methods: Two hundred two patients scheduled to undergo foot or ankle surgery by one of 7 fellowship-trained foot and ankle surgeons were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey independently. Differences between patient and surgeon overall expectations scores, number of expectations, and number of expectations with complete improvement expected were assessed. A difference of ≥10 points was considered a clinically important difference in expectations score. Associations between patient demographic and clinical characteristics, major/minor surgery, and individual surgeon with differences in expectations were also assessed. Results: Overall, 66.3% of patients had higher expectations, 21.3% had concordant expectations, and 12.4% had lower expectations compared with their surgeons. On average, patients had higher expectations scores than their surgeons (70 ± 20 vs 52 ± 20 points, P < .001). Patients expected complete improvement in a greater number of expectations than surgeons (mean 11 ± 7 vs 1 ± 3, P < .001). Patients had higher expectations than surgeons for 18 of 23 items (78%). Items that had the greatest number of patients with higher expectations than surgeons were “improve confidence in foot/ankle,” “prevent foot/ankle from getting worse,” and “improve pain at rest.” Higher body mass index (BMI) ( P = .027) and individual surgeon ( P < .001) were associated with greater differences between patient-surgeon expectations. Major/minor surgery was not associated with differences in expectations ( P ≥ .142). Conclusion: More than two-thirds of patients had significantly higher expectations than their surgeons. Higher BMI was associated with higher patient than surgeon expectations. These results emphasize the importance for foot and ankle surgeons to adequately educate patients preoperatively. Level of Evidence: Level II, prospective comparative study.

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Level of Evidence and Authorship Trends in Foot and Ankle Related Trauma Publications

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00100 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0010

Author(s):

Bradley Alexander ◽

James R. Jones ◽

Spaulding F. Solar ◽

Abhinav Agarwal ◽

Benjamin B. Cage ◽

...

Keyword(s):

Trauma Surgery ◽

Median Number ◽

Quality Level ◽

Foot And Ankle ◽

Level Of Evidence ◽

Ankle Surgery ◽

Level 3 ◽

Over Time ◽

Publication Quality ◽

Number Of Authors

Category: Other Introduction/Purpose: Evidence-based research in the field of foot and ankle related trauma surgery has increased significantly over the past two decades and considerable emphasis is being put on publication quality and level of evidence (LOE). With foot and ankle surgery being a relatively new and growing field of orthopedics, minimal analysis has been performed on the LOE and authorship trends in foot and ankle related trauma publications. The purpose of this study is to evaluate LOE and authorship characteristics in foot and ankle related trauma publications in three different high impact factor journals. Methods: All of the foot and ankle related trauma publications from the years 1997, 2002, 2007, 2012, and 2017 in Foot and Ankle International (FAI), Journal of Trauma (JOT), and The Journal of Bone and Joint Surgery (American and British volumes) (JBJS) were analyzed. LOE of each article was determined by two external reviewers based on the JBJS LOE grading system. Country of origin for the first, last, and corresponding author of each article was evaluated, and fellowship data was obtained from a database for all United States authors. LOE, authorship, and publication trends were compared between both journals and publication year. Results: Over the 15-year period therapeutic studies were the prominent studies in all three journals. JBJS published the highest quality level of evidence and did not publish any level V evidence. The median number of authors was highest in JBJS. JOT publishes a majority of articles from North America (65%) while JBJS publishes more internationally (48% North American). Number of authors increased over time from a median of 3 in 1997 to a median of 5 in 2017. When evaluating the articles with available authorship fellowship data, JBJS and JOT had the highest percentage of articles with a trauma fellowship trained author at 77% and 53%, respectively. FAI had the highest percentage of articles with a foot and ankle fellowship trained author at 34%. Conclusion: From 1997 to 2017, there has been an increase in level 3 evidence foot and ankle related trauma publications and an emphasis on studies being conducted by fellowship trained authors. While the percentage of authors with MDs per publication remained similar over time, this study shows that publications have gradually increased the number of authors over time. There are key differences between the journals including level of evidence. [Table: see text]

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Fulfillment of Expectations After Orthopedic Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100719864354 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1249-1259 ◽

Cited By ~ 3

Author(s):

Jensen K. Henry ◽

Andrew Roney ◽

Elizabeth A. Cody ◽

Amelia Hummel ◽

Carol A. Mancuso ◽

...

Keyword(s):

Outcome Measures ◽

Roc Curves ◽

Foot And Ankle ◽

Patient Centered ◽

Level Of Evidence ◽

Score Improvement ◽

Level Ii ◽

Ankle Surgery ◽

The Mean ◽

Shoe Wear

Background: To date, no study has assessed fulfillment of patients’ expectations after foot and ankle surgery. This study aimed to validate a method of assessing expectation fulfillment in foot/ankle patients postoperatively. Methods: Preoperatively, patients completed the expectations survey, consisting of 23 questions for domains including pain, ambulation, daily function, exercise, and shoe wear. At 2 years postoperatively, patients answered how much improvement they received for each item cited preoperatively. A fulfillment proportion (FP) was calculated as the amount of improvement received versus the amount of improvement expected. The FP ranges from 0 (no expectations fulfilled), to between 0 and 1 (expectations partially fulfilled), to 1 (expectations met), to greater than 1 (expectations surpassed). Receiver operating characteristic (ROC) curves and areas under the curve (AUCs) with 95% confidence intervals (CIs) were used to compare the expectations survey to other outcome surveys, including Foot and Ankle Outcome Score, improvement, overall fulfillment, Delighted-Terrible scale, and satisfaction. Results: Of the 271 patients (mean age 55.4 years, mean BMI 27.5, 65% female), 34% had expectations surpassed (FP >1), 4% had expectations met, 58% had expectations partially fulfilled (FP between 0 and 1), and 5% had no expectations met. The mean FP was 0.84 ± 0.41 (range 0-3.13), indicating partially fulfilled expectations. FP correlated significantly with all outcome measures ( P ≤ .007). FP was associated most closely with satisfaction ( r = 0.66 [95% CI 0.57-0.75]; AUC = 0.92 [95% CI 0.88-0.96]; P < .001) and improvement ( r = 0.73 [95% CI 0.64-0.81]; AUC = 0.94 [95% CI 0.91-0.96]; P < .001). Based on the associations with satisfaction and improvement outcomes, a clinically important proportion of expectations fulfilled is 0.68, with sensitivity 0.85-0.90 and specificity 0.84-0.86. Conclusion: The proportion of expectations fulfilled is a novel patient-centered outcome that correlated with validated outcome measures. The expectations survey may be used by surgeons to counsel patients preoperatively and also to assess patients’ results postoperatively. Level of Evidence: Level II, prospective comparative series.

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

Foot & Ankle International ◽

10.1177/1071100718794851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 98-104 ◽

Cited By ~ 5

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.

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Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

Foot & Ankle International ◽

10.1177/1071100718799758 ◽

2018 ◽

Vol 40 (1) ◽

pp. 56-64 ◽

Cited By ~ 9

Author(s):

Man Hung ◽

Judith F. Baumhauer ◽

Frank W. Licari ◽

Jerry Bounsanga ◽

Maren W. Voss ◽

...

Keyword(s):

T Test ◽

Measurement Information ◽

Foot And Ankle ◽

Level Of Evidence ◽

Paired Samples ◽

Level Ii ◽

Patient Reported ◽

Prospective Comparative Study ◽

Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

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

Foot & Ankle International ◽

10.1177/1071100720903723 ◽

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.

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Patient Factors Associated With Higher Expectations From Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100717690807 ◽

2017 ◽

Vol 38 (5) ◽

pp. 472-478 ◽

Cited By ~ 18

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.

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Trends in Foot and Ankle Publications

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00451 ◽

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.

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Return to Driving After Foot and Ankle Surgery: A Novel Survey to Predict Passing Brake Reaction Time

Foot & Ankle Specialist ◽

10.1177/1938640019890970 ◽

2020 ◽

pp. 193864001989097 ◽

Cited By ~ 1

Author(s):

Elizabeth L. McDonald ◽

Rachel Shakked ◽

Kristen Nicholson ◽

Joseph N. Daniel ◽

David I. Pedowitz ◽

...

Keyword(s):

Reaction Time ◽

Traffic Safety ◽

Foot And Ankle ◽

Highway Traffic ◽

Clinical Tool ◽

Level Of Evidence ◽

National Highway Traffic Safety ◽

Level Ii ◽

Internal Inconsistency ◽

The Right

Introduction. Brake reaction time (BRT) is an accepted method for establishing recommendations for safe return to driving by the National Highway Traffic Safety Administration. Other than performing a BRT test in clinic, there is no established clinical tool to help physicians differentiate safe from unsafe drivers once patients reach general recovery milestones. The purpose is to present individual recommendations to the patient through a novel, validated survey evaluating safe return to driving after orthopaedic surgery of the right foot and ankle. Methods. A total of 171 patients undergoing 1 of 3 specific foot and ankle procedures were prospectively enrolled. A 4-question survey and BRT were completed 6 weeks postoperatively. The following questions were asked: (1) “I think my brake reaction time is slower than most drivers my age,” (2) “I think my brake reaction time is faster than most drivers my age,” (3) “I think my brake reaction time is about the same as most drivers my age,” (4) “Based on what I think my brake reaction time is, I think I am ready to drive.” Internal consistency was determined with Cronbach’s α and item total correlation. External validity was determined by Spearman’s correlation coefficient. A BRT less than 0.850 s was considered as a pass. Results. Of 171 patients, 162 (95%) with ages ranging from 21 to 83 years achieved a passing BRT by 7.6 weeks. After removing 1 question because of internal inconsistency, the optimal threshold for predicting passing BRT was 10/15 points or higher, which had 99% probability of success that a patient would pass the BRT (95% CI = 96%, 100%). Conclusion. This novel, 3-question driving readiness survey can accurately predict a passing BRT Achilles rupture repair, total ankle arthroplasty, and hallux valgus correction performed in the right foot and ankle as early as 6 weeks postoperatively. Level of Evidence: Level II: Comparative study

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