No abstract

Background: No study has examined the incidence of risk factors for postoperative falls following foot and ankle surgery. We investigated the incidence and risk factors for postoperative falls in foot and ankle surgery using inpatient and outpatient population. Methods: A single fellowship-trained foot and ankle surgeon instituted collection of a postoperative fall questionnaire at 2 and 6 weeks postoperatively. A retrospective review of 135 patients with complete prospectively collected fall questionnaire data was performed. Patient demographic information, injury characteristics, comorbidities, baseline medications, length of hospital stay, visual analog scale (VAS) pain scores were collected. After univariable analysis, a multivariable binary logistic regression was conducted to assess independent risk factors for postoperative falls. Results: The median (interquartile range) age was 52 (21) and body mass index was 32.7 (11.1). A total of 108 patients (80%) underwent outpatient procedures. Thirty-nine of the 135 patients (28.9%) reported experiencing a fall in the first 6 weeks after surgery. In multivariable analysis, antidepressant use (adjusted odds ratio 3.41, 95% CI 1.19-9.81) and higher VAS pain scores at 2 weeks postoperatively (adjusted odds ratio 1.27, 95% CI 1.08-1.50) were found to be independent risk factors for postoperative falls. Conclusion: This study found a high incidence of postoperative falls in the first 6 weeks after foot and ankle surgery. Baseline antidepressant use and higher 2-week VAS pain scores were associated with postoperative falls. Foot and ankle surgeons should discuss the risk of falling with patients especially those with risk factors. Level of Evidence: Level III, retrospective cohort study at a single institution.

Resilience is a dynamic construct defined as the ability to recover from stress. There is no literature examining the impact of resilience on outcomes following foot and ankle surgery. Retrospective analysis of patients who underwent first MTP arthrodesis from September 2011 to May 2020 were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and Foot Function Index (FFI) were collected. Resilience was measured using the Brief Resilience Scale. A multivariable linear regression analysis examining the impact of resilience on patient reported was conducted. At an average of 3.4 years postoperatively, resilience was found to independently affect patient reported outcomes across all instruments, except the FFI pain subscale. In the first study examining the impact of resilience following foot and ankle surgery, we found that resilience has an independent positive effect on overall physical function, disability, pain, and mental health following MTP arthrodesis. Preoperative resilience scores could be used to predict postoperative functional outcomes following MTP arthrodesis and guide postoperative rehabilitation. These findings help establish the role of early positive psychosocial characteristics within orthopaedic foot and ankle population.

No abstract

Category: Hindfoot Introduction/Purpose: Plantar fasciitis and achilles tendonopathy are two of the most common foot and ankle overuse conditions encountered in clinical practice. Several recent studies have shown isolated gastrocnemius recession to be a viable treatment option for these conditions when conservative management has failed. Patient outcomes have primarily been assessed through pain and functionality scores. While pain improvement and motion restoration are of utmost importance, plantar flexion power and endurance are also key to patients’ ability to return to everyday activities. Here, we assess patient outcome scores of individuals that underwent gastrocnemius recession for plantar fascitis and achilles tendonopathy to see if surgery was beneficial. Methods: We reviewed 160 patients who underwent isolated gastrocnemius recession for chronic plantar fasciitis and achilles tendinopathy by a single surgeon from June 2011 to August 2018. Data was collected regarding patient pre-operative and post- operative pain scores at 3 months, 1 year, and final follow-up, and post-operative PROMIS physical function (PF), pain interference (PI), and depression (D) t-scores at final follow-up. We also collected data regarding time to full weight bearing, time to 50% and 100% pain relief, time to return to work, time to return to ADL, and time for patient to be out of boot. The patient population was then stratified by preoperative diagnosis and if patients received formal physical therapy. The cohorts consisted of patients that had plantar fasciitis, Achilles tendinosis, or a combination of both. The other cohorts were patients that received formal physical therapy and those that did not receive physical therapy. Results: The average preopeartive VAS score fot plantar fasciitis Achilles tendinosis and a combination of both was 4.27 4.10 and 4.93 respectively. For patients that had 3 month follow up (96) all three cohorts saw a decrease in VAS scores at 3 months (1.98, 1.50, and 1.80 respectively). Patients who received physical therapy saw a larger decrease in VAS scores (2.05 vs 1.03 respectively). Patients in all three groups were able to be fully weight baring within 30 days. 20.27 days in the plantar fasciitis, 19.25 for Achilles tendinopathy, and 28.3 days in the combination cohort. Patients with Achillis tendinosis had were able to get out of their boot the fastest (29.75 days). PROMIS scores were similar across all cohorts. Conclusion: This study is the first to complete a through evaluation of patient outcomes after gastrocnemius recession. Additionally, the study is one of the largest cohorts. This study helps to confirm that the surgery is beneficial for both plantar fasciitis and achilles tendinosis. In all cohorts patients pain improved with surgical intervention despite preoperative diagnosis and physical therapy status. Additionally, PROMIS scores across all of the patients were similar and did not indicate any signifcant decreases in physical function or increases in pain. [Table: see text]