scholarly journals Do Geographic Region, Pathologic Chronicity, and Hospital Affiliation Affect Access to Care Among Medicaid- and Privately-Insured Foot and Ankle Surgery Patients?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Charles C. Pitts ◽  
Haley M. McKissack ◽  
Jun Kit He ◽  
Bradley Alexander ◽  
Charles R. Sutherland ◽  
...  
Keyword(s):  
Access To Care ◽  
Success Rate ◽  
Hallux Valgus ◽  
Private Insurance ◽  
Foot And Ankle ◽  
Chronic Injury ◽  
Phone Calls ◽  
Ankle Surgery ◽  
Academic Practices ◽  
Geographic Regions

Category: Other Introduction/Purpose: Studies have shown that patients enrolled in Medicaid have difficulty obtaining access to care compared to patients with private insurance. Whether variables such as geographic location, state expansion vs. non-expansion, and private versus academic affiliation affect access to care among foot and ankle surgery patients enrolled in Medicaid has not been previously established. Methods: Twenty providers from each of five Medicaid-expanded and five non-expanded states in different U.S. geographic regions were randomly chosen via the American Orthopaedic Foot & Ankle Society (AOFAS) directory. One investigator contacted each office requesting the earliest available appointment for their fictitious relative’s acute Achilles tendon rupture or hallux valgus. Investigator insurance was stated to be Medicaid for half of phone calls, and Blue-Cross Blue-Shield (BCBS) for the other half. Appointment success rate and average time to appointment were compared between private insurance and Medicaid. Results were further compared across geographic regions, between private and academic practices, and between urgent acute injury (Achilles rupture) and chronic non-urgent injury (hallux valgus). Results: Appointments were successful for all 100 (100%) calls made with BCBS, in comparison to 73 of 100 calls (73%) with Medicaid (p<0.001). Both acute and chronic injury had significantly higher success rates with BCBS than Medicaid (p<0.001). Appointment success rate was significantly lower with Medicaid than with BCBS (p<=0.01) in all geographic regions. Success rate with Medicaid (66.7%) was significantly lower than with BCBS (100.0%, p<0.001) for private practice offices, but not for academic practices. Conclusion: Patients with Medicaid experience difficulty in obtaining appointments for common non-emergent foot and ankle problems and may experience increased difficulty scheduling appointments at private rather than academic institutions. The medical community should continue to seek and identify potential interventions which can improve access to orthopaedic care for all patients, regardless of insurance status. [Table: see text]

Popliteal Blocks for Foot and Ankle Surgery: Success Rate and Contributing Factors

2014 ◽  
Vol 53 (2) ◽  
pp. 176-178 ◽  
Author(s):  
Kenneth Hegewald ◽  
Kevin McCann ◽  
Andrew Elizaga ◽  
Byron L. Hutchinson
Keyword(s):  
Success Rate ◽  
Foot And Ankle ◽  
Contributing Factors ◽  
Ankle Surgery

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.

scholarly journals Do Type of Insurance, Geographical Variation and Type of Practice Impact Access to Foot and Ankle Care?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Mohit Jain ◽  
Haley McKissack ◽  
Jun Kit He ◽  
Aaradhana J. Jha ◽  
Matthew Anderson ◽  
...  
Keyword(s):  
New York ◽  
Success Rate ◽  
Tendon Rupture ◽  
Private Insurance ◽  
Achilles Tendon Rupture ◽  
Wait Time ◽  
The State ◽  
Medicaid Expansion ◽  
Foot And Ankle ◽  
Significant Difference

Category: Foot & Ankle Introduction/Purpose: Medical coverage gap in United States refers to people who are uninsured because the state they are living has still opted-out of Medicaid expansion under Patient Protection and Affordable Care Act (PPACA) and they are too poor to be benefited from subsidies designed for middle-class Americans. A large percentage of this population lives in south. Despite increasing participation of the states in expanded Medicaid, it is still unclear that if such an expansion has led to improve the access to care. However, approximately one in three American is covered under Blue Cross Blue Shield (BCBS) private insurance. The purpose of this study is to determine the access to foot and ankle care based on medical insurance, nature of illness and Medicaid expansion of the state. Methods: Five pairs of Medicaid expended (California, New York, Ohio, Minnesota and Washington) and non-expanded (Utah, Texas, Alabama, Missouri, and North Carolina) states with different geographic location were selected for the study. Twenty providers from each state were randomly selected via American Orthopedic Foot & Ankle Society (AOFAS) directory with private or academic affiliations. Each provider’s office was contacted by fictitious call for the earliest available appointment in foot and ankle clinic. A standardized script was used by the same researcher every time for a 30 year old male patient with acute Achilles tendon rupture or chronic bunion with either Medicaid or BCBS insurances. Available appointment for physician was considered as an access to foot and ankle care. We registered time until appointment (if given) and reason for denial (if denied) on phone. We also recorded requirements for insurance details, PCP (Primary Care Physician) referral or imaging records. Results: 200 providers’ offices were contacted on phone for foot and ankle clinic appointment. Successful appointment was given by 36%(72/200) offices irrespective of condition and insurance. 29% of calls with Medicaid could successfully schedule an appointment compared to 43% when calling with BCBS(P=0.03). Success rate for appointment was same for Achilles rupture and Bunion (36% each). The mean time until earliest appointment was 10.7(range 1-37) days with Medicaid and 10.5 (range 1-45) days with BCBS. For Medicaid patients, no significant difference was found in appointment rates between expanded states (30%) and non-expanded (28%) states (P=0.82). Overall appointment success rate was highest in Utah (65%) and lowest in New York (10%). Differences were observed across geographical locations, as well as between academic and private institutes. Conclusion: In our study, access to foot and ankle care clinic seems to be significantly better with BCBS private insurance compared to Medicaid. Sample size is surely a limitation, but we have included more states than similarly-designed studies for better geographic variability. There was no significant difference for appointment wait-time between Achilles tendon rupture and Bunion as well as Medicaid and BCBS insurance. Medicaid expansion facility in the state has not been associated with higher success rate but associated with lengthening of wait-time. Inability to provide insurance details or PCP-referral is definitely an important barrier for the access to podiatric care.

scholarly journals A new path for the Journal of the Foot & Ankle - JFA

2020 ◽  
Vol 14 (1) ◽  
pp. 1
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Cristian Ortiz ◽  
Daniel Baumfeld ◽  
Gabriel Khazen ◽  
Luis Hermida ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Research Community ◽  
Hard Work ◽  
Foot And Ankle ◽  
Common Goal ◽  
Treatment Results ◽  
High Quality ◽  
Phone Calls ◽  
Ankle Surgery

Hard work is the key to success. It may sound like a cliché, but the preparation and the release of this first edition of the new Journal of the Foot & Ankle (JFA) were based on this very concept, and we took it very seriously! For years many of us have dedicated time and efforts to bring this Journal to life. After countless meetings, discussions, phone calls, WhatsApp messages, and an infinite amount of writing, our collaborative hard work and friendship finally brought us here! Now we need to stay focused and ahead of the game, looking forward to the future and the innovations. We should aim to publish high-quality, unbiased research, with emphasis on strong clinical evidence. Our vision is to support researchers and research that can enable the Orthopaedic Foot and Ankle Surgery Community to understand better the complexity of the pathologies, guide treatment, and, most importantly, improve the treatment results and quality of life of our patients. Our thoughts are that keeping all these goals in mind will allow us to achieve the expected acceptance and respect of the research community, as well as the desired indexation. It is not an easy task! But we are confident we can get there with your help! We’re great believers in working as a team towards a common goal, and we are sure that with the help of our dedicated Foot and Ankle colleagues and researchers, we will soon make our vision become a reality! Let’s do it together!

Prevalence of Accessory Ossicles and Sesamoid Bones in Hallux Valgus

2013 ◽  
Vol 103 (3) ◽  
pp. 208-212 ◽  
Author(s):  
Umile Giuseppe Longo ◽  
Andrea Marinozzi ◽  
Stefano Petrillo ◽  
Filippo Spiezia ◽  
Nicola Maffulli ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Final Decision ◽  
Foot And Ankle ◽  
Detailed Report ◽  
Accessory Ossicles ◽  
Single Center Study ◽  
Ankle Surgery ◽  
Significant Difference ◽  
Sesamoid Bones ◽  
Italian Women

Background: Sesamoid bones and accessory ossicles of the foot and ankle, although mostly asymptomatic, can be sources of pain or degenerative changes in response to overuse and trauma. We investigated the prevalence of accessory ossicles and sesamoid bones in a population of Italian women with hallux valgus. Methods: A single-center study was performed to determine the prevalence of accessory ossicles and sesamoid bones in the ankle and foot. A total of 505 women with hallux valgus aged 26 to 80 years at the time of hallux valgus correction were examined. Anteroposterior, oblique, lateral foot radiographs and a Muller view were examined regarding the presence, prevalence, coexistence, and distribution of accessory ossicles and sesamoid bones in both feet. The radiographs were analyzed independently by three experienced specialists in foot and ankle surgery. Disagreements were discussed in a consensus meeting, where the radiographs were reevaluated and a final decision was made. Results: There was no statistically significant difference between data of the accessory ossicles and sesamoid bones according to the χ2 test. Sesamoid bones were detected in 404 of the 505 patients. The fifth metatarsal sesamoid bone was found in 97 patients. All of the patients presented hallucal sesamoid bones. Conclusions: This is the first detailed report of the prevalence of accessory ossicles and sesamoid bones of the feet in Italian women with hallux valgus. These findings could help clinicians in the diagnosis and management of disorders of accessory ossicles and sesamoid bones, which are often undiagnosed, painful foot syndromes. (J Am Podiatr Med Assoc 103(3): 208–212, 2013)

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.

Deep Venous Thrombosis and Pulmonary Embolism as Rare Complications After Hallux Valgus Surgery

2013 ◽  
Vol 103 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Faik Altintaş ◽  
Turhan Özler ◽  
Melih Güven ◽  
Afşar Timuçin Özkut ◽  
Çağatay Uluçay
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Hallux Valgus ◽  
Varicose Veins ◽  
Early Mobilization ◽  
Thromboembolic Disease ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Life Threatening

The incidence and life-threatening complications of thromboembolic disease after major orthopedic surgical procedures have been extensively defined in the medical literature. However, there are few studies concerning the incidence of thromboembolic disease after foot and ankle surgery. We describe a 57-year-old female patient who underwent surgery for bilateral hallux valgus deformities and was diagnosed as having deep venous thrombosis and pulmonary embolism after the surgery despite early mobilization and mechanical prohylaxis. Her preoperative physical examination revealed varicose veins in both cruris. She was treated for pulmonary embolism with low-molecular-weight heparin and an oral anticoagulant in the postoperative period. Although venous thromboembolism is more commonly described after proximal lower-extremity procedures, it can occur after foot and ankle surgery, particularly if the patient has certain risk factors. Therefore, in addition to mechanical prophylaxis, pharmacologic prophylaxis should be kept in mind in such patients. (J Am Podiatr Med Assoc 103(2): 145–148, 2013)

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