Background: Weightbearing restrictions following foot and ankle surgery require the use of appropriate assistive devices for nonweightbearing ambulation during the recovery period. Selecting an appropriate assistive device that safely optimizes mobility and participation in daily activities is important to patient compliance and satisfaction. The purpose of this study was to compare physiologic demand, perceived exertion, and patient preference between a hands-free single crutch (HFSC) and standard axillary crutches (SACs) in foot and ankle patients. Methods: Using 44 preoperative orthopedic foot and ankle patients who had a mean age of 32 (19-51) years, a prospective, randomized, crossover study was performed. The sample consisted of 35 males and 9 females. The mean body mass index (BMI) was 26 (19-36), the mean height was 1.7 m, and the mean weight was 82 kg. Patient data and preactivity heart rate were recorded for all patients, who were then randomized to either an HFSC or SACs. Each patient was randomly assigned to the device they would utilize first using a random number generator. They then crossed over to the other device after vitals returned to within 10% of their baseline heart rate. Every subject completed a 6-minute walk test (6MWT) using both assistive devices in a crossover manner. Immediately following each 6MWT, postactivity heart rate, self-selected walking velocity (SSWV), perceived exertion using the OMNI Rating of Perceived Exertion (OMNI-RPE), and perceived dyspnea using the Modified Borg Dyspnea Scale were obtained. After completing both 6MWTs, patients were asked which assistive device they preferred the most. Results: The HFSC was preferred by 86% of patients. Significantly lower dyspnea scores (2.8 vs 5.3; P < .001), fatigue scores (2.4 vs 5.5; P < .001), preactivity and postactivity change in heart rate (28 vs 46 bpm; P < .001), and mean postactivity heart rate (107 vs 122 bpm; P < .001) were found using the HFSC compared with the SACs. The SAC group trended toward a higher SSWV (0.8 vs 0.77 m/s; P = .08). Those with a BMI greater than 25 also preferred iWALK over SACs ( P < .05). Neither group had any falls. Sixty-eight percent of patients complained of axillary/hand pain with the SACs, while 7% complained of proximal leg strap discomfort with the HFSC. Conclusion: The results of the current study in our relatively healthy cohort found that foot and ankle patients who were nonweightbearing preferred the HFSC over SACs. They experienced less physiologic demand as well as discomfort and perceived less exertion when using the HFSC compared with SACs. Level of Evidence: Level II, prospective comparative study.

Background: The purpose of this study was to compare postoperative foot and ankle patient-reported visual analog pain scores (VAS) to nursing staff and the treating surgeon during a single encounter. Prior literature established preoperative patients reported higher pain scores to a surgeon as compared to nursing staff. We hypothesized that there will be no differences in postoperative patients’ pain scores when reporting to nursing staff vs a surgeon. Methods: This study was a retrospective cohort of 201 consecutive postoperative foot and ankle patients with 3 follow-up encounters treated by a single surgeon. The patients were asked to rate their pain intensity using the VAS with 0 “no pain” and 10 “worst pain” at 2, 6, and 12 weeks postoperatively by a nurse and surgeon. Results: At all time intervals, the mean pain score was significantly higher when reported to the surgeon, although these were not clinically relevant. The mean scores at 2 weeks were 2.8 reported to the surgeon and 2.5 reported to the nurse ( P < .001). The mean scores at 6 weeks were 2.0 reported to the surgeon and 1.8 reported to the nurse ( P = .002). The mean scores at 12 weeks were 2.3 reported to the surgeon and 2.0 reported to the nurse ( P = .005). Conclusion: This study found that postoperative foot and ankle patients did not overemphasize their VAS pain scores to the physician vs nursing staff. These findings contrast with our 2 previous studies that found preoperative and nonoperative patients reported clinically significant higher scores to the surgeon. Level of Evidence: Level III, comparative study.

Category: Patient Reported Outcome Measures Introduction/Purpose: The relativity of pain adds to the increasing ambiguity of deciding proper treatment procedures. Reliable and validated patient reported outcome measures have attempted to solve this problem, but there are still flaws due to the subjective nature of pain. This study is the third part to two previous studies that found both operative and new nonoperative patients overemphasize their pain scores when reporting to the treating physician as compared to a nurse. This current study aims to examine if this phenomenon holds true with orthopedic postoperative patients. The importance of this study is to observe this phenomenon, as to better understand subjective pain scores. We hypothesize there will be no differences in postoperative patients’ pain scores when reporting to a treating physician versus a nurse. Methods: This study is a retrospective cohort of consecutive postoperative foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal visual analog scale (VAS) 0 to 10, from “no pain” to “worst pain” at 2, 6, and 12 weeks postoperatively. Differences in reported pain levels were analyzed within each clinic visit. Results: Two hundred and one patients each with 3 follow up encounters were included in our cohort. The mean 2, 6, and 12- week postoperative VAS scores reported to the physician were 2.85, 2.04, and 2.33 respectively; in comparison, the scores reported to the nurse were 2.52 (p=0.0005), 1.77 (p=0.002), and 2.02 (p=0.005) respectively. There was no significant relationship between time and type of provider. Conclusion: This study found that postoperative patients report their pain more consistently to physicians and nursing staff with no clinically significant differences noted. These findings stand in stark contrast to our two previous studies which noted new and preoperative patients reported significantly higher VAS scores to the physician. The reason for reporting inconstancies is unclear, but postoperatively patients no longer need to emphasize their impairments or injury. Postoperatively, they also have a defined time interval and more acute recollection of their pain potentially leading to more consistency in reporting.