Search

There is growing interest in adopting validated and reliable patient-reported outcome measures following surgery. While the Foot and Ankle Outcome Score (FAOS) has previously been validated for use in multiple foot/ankle conditions, it has not yet been validated in patients with infracalcaneal heel pain. In this study we aimed to validate the FAOS by looking at 4 psychometric properties of the survey: construct validity, content validity, reliability, and responsiveness, using patients in our practice with a clinical diagnosis of plantar fasciitis. A total of 150 patients (mean age 49.7 ± 12.1 years [36 men and 114 women]) were included in one or more of the 4 components of this study. All FAOS subscales demonstrated adequate construct validity when compared with the physical health component of the 12-Item Short Form Health Survey (SF-12), and 2 out of 5 subscales demonstrated moderate correlation with the mental health component of SF-12 (all Spearman rho >0.3, and p values <0.05). Most FAOS subscales demonstrated content validity and were found to contain relevant questions from the patient's perspective. All 5 subscales demonstrated good test-retest reliability with intraclass correlation coefficients ≥ 0.827. Finally, 4 out of the 5 subscales (all but other symptoms) were responsive to change at a mean follow up of 12.2 months after surgery (p < .05). We conclude that the FAOS is a responsive, reliable, and valid instrument for use in infracalcaneal heel pain. We believe that due to its ease of use and broad applicability, the FAOS could be more widely adopted in foot/ankle practices as patient-centered healthcare delivery and research becomes increasingly prioritized in the US and abroad., (Copyright © 2022 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Treatment of subacute and chronic heel pain often presents a unique challenge to the physician. Regenerative therapies, such as injectable amnion and connective tissue matrix, may represent a promising new approach in these patients, and have become increasingly popular in the United States. However, little literature exists evaluating these injections compared to conventional nonoperative means. As such, we designed a retrospective comparative study evaluating patients in our practice who received a standardized plantar fascial treatment protocol only (standard therapy), and those who received regenerative plantar fascial injections in addition to standard therapy. A total of 54 patients were followed over a 3-month observation period (91.7 ± 73.9 days), with numeric pain rating (NPR) serving as the primary outcome. Both groups saw an improvement in NPR at the end of the observation period, but patients in the regenerative therapy group demonstrated lower pain scores than those receiving standard therapy alone (mean NPR 2.1 ± 2.3 vs 4.4 ± 2.8, p = .004). Additionally, those in the standard therapy group were significantly more likely to proceed onto surgical intervention compared to the regenerative therapy group (unadjusted odds ratio 15.6, 95% CI 3.0-27.9). The use of regenerative injections for subacute and chronic plantar fasciitis showed promise in our study, and may help mitigate against the need for invasive surgical intervention., (Copyright © 2022 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Although many surgeons believe that shortening osteotomies are appropriate in patients with metatarsalgia and long second metatarsals, there remains ambiguity regarding when to repair the injured plantar plate and when to leave it alone. We prospectively assessed consecutive adult subjects who underwent an isolated second Weil metatarsal osteotomy (WMO) or a WMO plus plantar plate repair (WMO + PPR) for sub-second metatarsophalangeal joint pain during a 3.5-year period at our practice. Eighty-six patients (86 feet: 21 WMO only and 65 WMO + PPR) with a mean age of 61 ± 11 years were followed for 1 year. Patients were assessed via use of the Foot and Ankle Outcome Score and radiographic parabola/alignment of the operative digit preoperatively and postoperatively. Patients in the WMO + PPR group demonstrated significant improvements preoperatively to postoperatively in 4 of the 5 FAOS subscales (Pain, Other Symptoms, Sport and Recreation Function, and Ankle- and Foot-Related Quality of Life [QoL], all p < .05) and had higher QoL and Pain subscale scores at 1 year compared with those in the WMO-only group (QoL: 68.6 ± 26.7 versus 49.7 ± 28.5, respectively [p = .01]; Pain: 83.2 ± 14.5 versus 73.6 ± 19.9, respectively [p = .04]). The WMO + PPR group tended to have higher-grade tears on intraoperative inspection (median 3, range 0 to 4) compared with those in the WMO group (median 1, range 0 to 3). There were otherwise no group differences in preoperative or postoperative radiographic parabola, alignment of the second toe, or complication rates. Our findings suggest that when a shortening osteotomy is performed, imbricating/repairing and advancing the plantar plate may be valuable regardless of injury grade in the plate., (Copyright © 2019 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Historically, the postoperative protocol for patients undergoing first metatarsophalangeal joint arthrodesis has included 6 weeks of non-weightbearing, followed by protected weightbearing in a below-the-knee cast boot or postoperative shoe. This prolonged period of non-weightbearing predisposes the patient to disuse atrophy, osteopenia, deep vein thrombosis risk, and, overall, a prolonged time to recovery. The present study reports a retrospective review of a patient cohort that underwent first metatarsophalangeal joint fusion with immediate full weightbearing postoperatively. Thirty consecutive first metatarsophalangeal joint arthrodeses were performed during the study period. Five patients were excluded secondary to insufficient postoperative follow-up data or a lack of adequate radiographic evaluation at regular postoperative intervals. Conical reamers were used for joint preparation. Internal fixation, consisting of a single cannulated interfragmentary compression screw and a dorsal locking plate, was used in all patients. The results showed that patients achieved clinical healing at an average of 5.92 weeks and showed radiographic fusion at an average of 6.83 weeks. The patients in the present study had an overall union rate of 96%. Complications included 1 nonunion, 1 superficial wound infection, 1 wound dehiscence, 1 case of symptomatic hardware, and 2 patients with symptomatic hallux interphalangeal joint arthralgia. The mean visual analog pain score preoperatively was 6.64 (range 4 to 8) and postoperatively was 0.6 (range 0 to 4). In conclusion, we found that immediate full weightbearing after first metatarsophalangeal joint fusion in the context of interfragmentary compression and locked plating techniques is a safe, predictable postoperative protocol that allows for a successful fusion interval and an early return to regular activity., (Copyright © 2018 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

The treatment of Jones fractures has been controversial in terms of nonoperative versus operative management, given the high incidence of nonunion secondary to the delicate blood supply to the proximal fifth metatarsal. We report a retrospective review of a patient cohort treated with an early weightbearing protocol after operative intramedullary fixation in acute Jones fractures. Thirty-one consecutive patients with an acute Jones fracture underwent operative fixation with a single intramedullary solid screw. The postoperative protocol consisted of immediate weightbearing in a controlled ankle motion boot for 2 weeks with a gradual transition to regular shoes at 2 weeks postoperative. At 2 weeks, the patients were allowed to perform low-impact activities such as walking, swimming, biking, or elliptical training. Patients were allowed to return to all activities, as tolerated, regardless of radiographic healing, at 6 weeks postoperatively. Serial postoperative radiographs were taken at 2-week intervals to determine radiographic union. Our patient population consisted of 24 males (77.42%) and 7 females (22.58%), with a mean average age of 37.5 ± 12.59 years and mean average body mass index of 25.7 ± 2.32 kg/m 2 . Fracture union was observed in all 31 patients (100%) at a mean average of 5.7 ± 1.47 (range 4 to 10) weeks. Two (6.5%) patients required hardware removal, with one (3.2%) experiencing sural neuritis. This review of patients undergoing early weightbearing after operative fixation of an acute Jones fracture demonstrated a satisfactory incidence of union compared with traditional postoperative protocols at a mean follow-up duration of 18.58 ± 5.66 months., (Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Success rates for traditional methods of surgical intervention for chronic plantar fasciosis are low, and associated with high rates of complications and long recovery times. The purpose of this prospective case series was to assess the effectiveness of percutaneous bipolar radiofrequency microfasciotomy for the treatment of recalcitrant proximal plantar fasciosis in 21 patients. The mean preoperative American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was 22.10 ± 12.96 (out of a possible 68 points) and the mean postoperative AOFAS hindfoot score was 59.57 ± 13.23 points, and this difference was statistically significant (P < .0001). A total of 7 (33.33%) patients experienced satisfactory pain relief within 1 to 4 weeks and 10 (47.62%) did so within 1 to 4 months, whereas 2 (9.52%) patients required longer than 4 months, and 2 (9.52%) others never attained satisfactory relief of symptoms. Fourteen (66.67%) patients subjectively rated their outcome as excellent, 4 (19.05%) as good, 1 (4.76%) as fair, and 2 (9.52%) as poor. One (4.76%) patient experienced iatrogenic flexor hallucis longus tendonitis. The results of this clinical investigation indicate that bipolar radiofrequency microdebridement plantar fasciotomy safely alleviates recalcitrant heel pain. The technique is minimally invasive and simple to perform, and it spares the overall integrity of the plantar fascia without being associated with undue complications., (Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)