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Category: Other Introduction/Purpose: Falls following orthopaedic surgery are a known entity in the healthcare field possessing significant patient morbidity and driving increased healthcare cost. The vast majority of studies have focused on the incidence and risk factors for postoperative falls in the inpatient setting, however, this is in direct contrast to shifts seen toward same-day outpatient orthopaedic surgery over the past decade. It is crucial to better understand the incidence and risk factors for falls in a mixed inpatient and outpatient model. Additionally, no study to date has examined the risk factors for falls after foot and ankle surgery. Methods: A total of 168 patients were administered a questionnaire and interviewed to investigate the incidence of postoperative falls. Patients completed surveys pertaining to fall history pre- and post-operatively, fall risks, current medical status, and use of an ambulatory assist device. Medical records were reviewed. Questionnaires and interviews were completed at 2 week and 6-week post-operative follow up visits. Factors found to be associated with postoperative falls in univariate analysis (p

Category: Other Introduction/Purpose: Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been shown to be predictive of postoperative success in orthopedic foot and ankle patients. The purpose of this study was to determine if an association exists between pre-operative PROMIS scores and patients going to the emergency department (ED) in the first 60 days following their operation. Methods: PROMIS scores, including physical function (PF) and pain inference (PI), were collected from 290 patients prior to foot and ankle procedures. Patients with presence of ongoing infection were excluded. Electronic medical record (EMR) data was retrospectively gathered for each patient to determine if they visited the ED for any reason during the first 60 days following their operation. A Backward Stepwise Logistic Regression analysis was conducted for postoperative ED visits with p

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Tarsal Coalition has been known to be associated with pes planovalgus, unrelenting pain, recurrent sprains, and arthrosis due to an abnormal connection between two or more bones of the feet following failure of segmentation during development. Three entities of coalition exist fibrous, cartilaginous and osseous. Most commonly patients present with pain during activity. On exam range of motion is usually limited and there may be valgus or varus malalignment of the hindfoot. Patients are often offered surgical resection following failure of conservative management. Few large cohort studies exist analyzing complications and patient reported outcomes of pediatric patients undergoing operative treatment. Methods: After IRB approval, patients under the age of 18 undergoing excision of tarsal coalition at a single academic center from 2010-2019 were identified. Medical records were reviewed for variables such as demographics, surgical technique, coalition characteristics, postoperative complications, and coalition recurrence. Patients were contacted via telephone to complete a PROMIS Physical Function and Pain Interference in addition to the Foot Function Index. Contact was attempted at least 3 times before a patient was considered non-respondent. A total of 44 patients and 54 feet were included in the analysis with 17 patients (22 feet) completing patients reported outcomes. Results: The median age at the time of surgery was 12 (IQR 3). Thirty-five feet (64.8%) were from male patients, while 19 feet (35.2%) were from female patients. Pain was the presenting symptom in 49 (90.7%) of feet. Pes planovalgus was present in 25 feet (46.3%). Forty feet (74.1%) had calcaneonavicular coalition compared to 12 feet (22.2%) with talocalcaneal coalition and 2 feet (3.7%) with both. Fibrous coalition was found in 19 feet (35.2%) and the most common. Interposition material was used in 49/54 (90.7%) feet. Wound complications or temporary neuropraxias were seen in 7/54 feet (13.0%), and coalition recurrence occurred in 3/54 feet (5.6%). At a median of 6 years (6.0 IQR) postoperatively, the median postoperative outcomes scores were as follows: PROMIS Physical Function 54.7 (17.9 (IQR)), PROMIS Pain Interference 38.7 (10.0), FFI Pain 14.0 (30.0), FFI Disability 1.0 (9.0), FFI Activity Limitation 3.0 (8.0), and FFI Total 6.0 (12.0). Conclusion: Our study investigated complications and long-term patient outcomes following coalition resection. At follow-up, pediatric patients who underwent excision of tarsal coalition had higher physical function and less pain than the average U.S. population (PROMIS population mean is score of 50). Our recurrence rate of 5.6% is lower than reported in literature. Infection rate was similar to reports in literature at 3.1%. Overall, Coalition resection in pediatrics is a well-tolerated procedure that improves both physical and emotional health.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal (MTP) joint arthrodesis of the hallux is a common and reliable procedure performed on patients with various pathologies including hallux rigidus and hallux valgus. While the effect of foot pathology on MTP arthrodesis union rates has been previously explored, there is a lack of literature comparing long term patient reported outcomes between pathology types. The purpose of this present study was to compare patient reported and clinical outcomes following MTP fusion between those with hallux valgus and hallux rigidus. Methods: Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Additionally, Radiographic follow-up of >12 weeks, no ongoing ipsilateral infection, and complete response to a postoperative patient report outcomes (PROMIS AND Foot Function Index (FFI)) survey were required. After these criteria, 112 patients remained and were grouped by hallux valgus (HV, 53) and hallux rigidus (HR, 59). Medical records were examined for patient characteristics, operative variables, and complications. Patients were grouped by indication and compared. Results: Nonunion rates and complications including wound dehiscence, infection, and reoperation were not different between indications. Patients completed the patient reported outcomes instruments a median of 1.9 years (IQR 2.6) postoperatively. All patient reported outcomes measures were not significantly different between pathology groups with PROMIS physical function ((median, IQR) HR 44.6, 9.9 vs. HV 44.1, 12.2), pain interference (HR 52.8, 9.9 vs. HV 52.4, 12.3), FFI pain scale (HR 33.3, 40.0 vs. HV 28.3, 37.0), FFI disability scale (HR 30.0, 41.0 vs. HV 28.9, 41.0), FFI activity limitation scale (HR 10.0, 27.0 vs. HV 10.0, 23.0), and FFI total (HR 25.8, 50 vs. HV 37.4, 37). Conclusion: Arthrodesis of the first MTP joint provides similar nonunion and complication rates between hallux valgus and rigidus groups. At intermediate follow-up, MTP arthrodesis provides comparable validated patient reported outcomes scores between these two groups. Surgeons should be aware of these results when prognosticating the effect of MTP arthrodesis.

Category: Other; Ankle; Midfoot/Forefoot Introduction/Purpose: Resilience is an interactive dynamic construct most simply defined as the ability to recover from stress. To date, there is no literature examining the impact of resilience on the outcomes following foot and ankle surgery. Methods: We retrospectively reviewed patients who underwent first MTP arthrodesis from September 2011 to May 2020, 98 met inclusion criteria. Medical records were reviewed for patient characteristics and union status. PROMIS Physical Function (PF), Pain Interference (PI), Depression (D), and the 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 outcomes while adjusting for potential confounding covariates was conducted. Results: At an average of 3.4+-2.6 (SD) years postoperatively, resilience was found to have an independent effect on patient reported outcomes across all instruments, except the FFI pain subscale. Resilience's effect on the instruments was as follows: PROMIS physical function (Unstandardized β 5.0, 95% CI 2.6 to 7.4), PROMIS pain interference (Unstandardized β -4.8, 95% CI - 7.8 to -1.8), PROMIS Depression (Unstandardized β -9.4, (95% CI -12.8 to -6.1), FFI disability subscale (Unstandardized beta -13.3, 95% CI -20.3 to -6.3 ), FFI activity limitation subscale (Unstandardized beta -15.7, 95% CI -23.0 to -8.5), FFI total (Unstandardized beta -11.7, 95% CI -18.1 to -5.4), and FFI pain subscale (Unstandardized beta -6.5, 95% CI -13.1 to.01). Conclusion: In this 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.

Category: Hindfoot Introduction/Purpose: The Evans/Mosca procedure remains the most utilized extra-articular osteotomies for correction of pes planus. This desired lengthening is created by inserting a graft in the anterior aspect of the calcaneus through a complete transverse osteotomy. Failure of conservative methods, particularly for rigid pes planus, is a primary consideration for surgical management. Complications of the Evans procedure include delayed union, nonunion, malunion, subluxation of the calcaneocuboid joint, and persistent lateral column pain. Our study analyzes risk factors for development of non-union. Methods: After IRB approval 120 patients charts and 157 feet were analyzed for incidence of non-union which was defined by clinical and radiographic evidence of absence of union >6 months. Delayed union was diagnosed if there was clinical evidence of healing without complete union at >6 months. Exclusion criteria included age >18 and revision lateral column lengthening. Patients' medical records were reviewed for basic demographics, complications, and surgical technique. Results: The cohort consisted of 75 females (47.8%) and 82 males (52.2%). The median age was 12 with an interquartile range (IQR) of 3. A total of 6 patients (3.7%) had wound complications or nerve injury. Nonunion occurred in 7 of 157 feet (4.5%) with 2 of 157 feet (1.3%) experiencing delayed union. The median age for patients with nonunion was significantly higher than those who achieved union (13.2 (IQR 2.75) vs. 11.2 (IQR 3) respectively). The fixation construct used was associated with increased risk of nonunion. Patients with screw fixation had the highest rate of nonunion at 50% (2/2) compared to pin and/or staple fixation at 6.8% (5/73), no fixation at 4% (3/75), and plate fixation at 0% (0/2). Both delayed union patients were treated with ultrasound bone stimulation, both patients were able to achieve complete union. Revision was attempted in 5/7 nonunions with all operative patients achieving union. Conclusion: Our study analyzed risk factors for developing non-union in patients undergoing calcaneal lengthening osteotomy for pediatric pes planus. We found age at time of surgery and graft fixation method to be significant risk factors for development of non-union. Our study highlighted that those patients who had non-union was on average >2yrs older at time of surgery. Overall, lateral column lengthening is a well-tolerated procedure with a complication rate, including non-and delayed union, of 10.8%. Surgeons should be aware, in the largest cohort of pediatric Evans/Mosca procedures to date, patient age and type of fixation were associated with nonunion.

Category: Hindfoot; Trauma Introduction/Purpose: Pilon fractures are often associated with severe bone comminution and soft tissue compromise. As a result, surgical salvage procedures such as hindfoot nailing may be indicated for patients who are not candidates for standard fixation techniques such as open reduction and internal fixation (ORIF). The purpose of this review was to access outcomes associated with complex hindfoot trauma acutely treated with hindfoot nailing. Methods: A case series at a Level I trauma center was performed to identify trauma patients with complex hindfoot fractures who underwent hindfoot nailing as definitive treatment after initial external fixation between 2012 and 2020. Indications included a combination of patient comorbidities, fracture severity, and soft tissue injury. Exclusion criteria included follow-up less than 3 months. Post-operative radiographs were interpreted by a fellowship-trained foot and ankle surgeon. Primary outcome measures included unplanned reoperation/revision and deep infection. Deep infection was defined as any patient requiring surgical debridement after definitive fixation with positive cultures or the presence of positive cultures at the time of planned surgery. Fractures were classified using the AO/OTA classification and injury characteristics and postoperative complications were recorded via chart review. Results: Twenty-six of 29 of identified patients met inclusion criteria. The most common AO/OTA classification was 43C (62%). The average age was 55 years (range, 31-94) and the most common mechanism of injury was motor vehicle crash (38%). Thirteen fractures (50%) were open with Gustilo Anderson grade IIIA fractures being the most common (38%). The overall deep infection rate was 15% with fifty percent of cases positive for a history of diabetes mellitus or smoking. Unplanned reoperations occurred in seven (27%) cases. Among these, a total of four (57%) occurred due to the development of deep infection, two (29%) were nonunions, and one (14%) was indicated for hardware failure. Below the knee amputation occurred in one patient with nonunion (4%), which was a grade IIIA open pilon fracture with significant bone loss. Union was achieved in the majority of patients (92%). Conclusion: Treatment of complex hindfoot trauma with intramedullary nailing has a high union rate as a salvage procedure in a poor host. Surgeons should consider this treatment in patients that are not candidates for standard open reduction and internal fixation techniques.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal (MTP) joint arthrodesis is commonly performed for end-stage hallux rigidus with largely satisfactory results. While current literature demonstrates union rates in the low 90's, there is still room for evolution of techniques and fixation constructs. The new Crossroads Dynaforce plate provides area for direct integration of a compression staple into the dorsal locking plate construct. The purpose of this present study was to compare outcomes of this new plating system to a standard dorsal locking plate from Stryker. Methods: Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Patients receiving Crossroads Dynaforce plates (23 patients) and Stryker Dorsal locking plates (21) for Hallux Rigidus were selected. Radiographic follow-up of >12 weeks and no ongoing ipsilateral infection were required for inclusion. Medical records were examined for patient characteristics, operative variables, and complications. PROMIS physical function, pain interference, and depression domains were collected postoperatively in addition to Foot Function Index (FFI). Results: The median age was 57.0 (IQR 16.0) with the average BMI of 30.4 (SD 11.2). No patient comorbidities or demographics were significantly different between Stryker and Crossroads groups. Importantly, the preoperative hallux valgus and intermetatarsal angles did not vary between groups. The use of an interfragmentary screw was significantly higher in the Stryker cohort 20/21 (95%) compared to 16/23 (70%) The rate of wound dehiscence, deep infection, and reoperation did not vary between groups. The nonunion rate did not differ between groups and was 3/21 (14.3%) in the stryker cohort compared to 1/23 (4.3%) in the Crossroads group. Patient reported outcomes measures did not differ between groups and were completed at an average of 2.2 years postoperatively (SD 1.9). Conclusion: The Crossroads Dynaforce plate provides comparable outcomes to a legacy dorsal locking plate from Stryker in hallux rigidus. In addition to clinical outcomes, patients report similar levels of function at intermediate term follow up.

Category: Hindfoot Introduction/Purpose: Tibiocalcaneal (TC) arthrodesis is commonly performed in patients with severe hindfoot disease. These include severe Charcot deformities, ankle malformations, chronic osteomyelitis (COM), and avascular necrosis (AVN). The talar vasculature becomes disrupted to the point that the bone can no longer be salvaged. The procedure involves performing a talectomy and fusing the tibia to the calcaneus. This helps in preserving the remaining hindfoot anatomy while allowing the patient to regain function and mobility. Our study highlights certain risk factors that influence the rate of postoperative complication after tibiocalcaneal surgery. Methods: We retrospectively reviewed the charts of 18 patients from a single institution who underwent tibiocalcaneal arthrodesis between the years of 2011 and 2019. Preoperative diagnoses, comorbidities, post-operative outcomes were noted among all patients. Then, the rates of non-union, below-knee amputations, revision surgeries, postoperative infections, and hardware failure were recorded. This data was then analyzed to determine which preoperative and perioperative factors affected postoperative outcomes for patients after tibiocalcaneal arthrodesis surgery. Results: Nonunion was the most commonly reported complication in this series. Eight of the eighteen patients were documented to have nonunion including three patients with stable pseudarthrosis. Diabetic patients had a slightly higher incidence of nonunion (4 of 7 patients) compared to those without diabetes (4 of 11 patients). Of the 9 patients diagnosed with Charcot arthropathy, 5 had nonunion. Three of five individuals with a BMI ranging from 25-30, and four of six individuals with a BMI of greater than 30 had a nonunion. Infection was a post-operative complication for four of the eighteen patients. Two of the four patients had multiple comorbidities in addition to chronic infections in the joint which were recurrent after surgery. Conclusion: In conclusion, TC arthrodesis provides a viable option for high risk patients with complicated ankle pathology who have not had successful outcomes from previous treatment. It is not without complications considering the comorbidities the patients present with before requiring this procedure. Further studies are necessary in order to validate the trends of outcomes and comorbidities of patients with TC arthrodesis.

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.

Category: Other; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Individuals with chronic foot pathologies often have an increased fall risk due to decreased power, deformity, or neuropathy. If patients do fall they can suffer injuries leading to emergency room visits, hospital admission, and surgery. Additionally, falls can increase the severity of their existing condition. This leads to an increase cost burden on the healthcare field and can ultimately decrease the quality of life for the patient. It is important to identify which foot pathologies are associated with the highest fall risk preoperatively and postoperatively. This study analyzes preoperative and postoperative fall data for patients with a variety of common forefoot, midfoot, and hindfoot pathologies. Methods: Over the course of 2019 70 patients had preoperative and 2-week and 6-week postoperative fall data collected in clinic prior to and after surgery. These patients were subdivided into three cohorts based on the location of foot pathology. This included 25 patients for forefoot, 20 patients for midfoot and 20 patients for hindfoot. We had patients complete several surveys that pertained to previous fall history, fall risks, fall history after surgery, current medical status, and use of an assistant device. The John’s Hopkins Fall Risk Assessment tool and the survey pertaining to fall risk from the national council on aging were validated surveys that were completed. Results: Patients that suffered from a hindfoot pathology had the highest risk of suffering a fall preoperatively. Of the 25 patients in the hindfoot cohort 36% experienced at least one fall in the 12 months prior to surgery. Patients with forefoot and hindfoot pathologies experienced the most falls prior to surgery (0.64 and 0.60 respectively). Postoperatively patients with midfoot pathologies had the highest frequency of falls with 35% experiencing at least one fall within the 2-week period after surgery. The midfoot cohort also experience the most falls postoperatively averaging 0.50 falls. Preoperatively all patients completed a John’s Hopkins fall risk assessment and the scores for forefoot midfoot and hindfoot were 6.32, 4.70, 6.96 respectively. With a score of over 6 indicating moderate fall risk. Conclusion: This information can help to identify which patients undergoing surgery for chronic foot pathologies are at the highest risk for preoperative and postoperative falls. Our study suggests that individuals with hindfoot pathologies are at greatest risk for preoperative falls and patients with midfoot pathologies have the greatest risk for postoperative falls. This study can help to guide patient management and decrease fall risk by understanding which patients are most susceptible. We are currently undertaking a prospective study looking at how preoperative mobility device training can reduce postoperative fall risk.

Category: Ankle; Trauma Introduction/Purpose: With the U.S. healthcare system focused on value of care, providers and hospitals are increasingly measured by factors that increase patient care and decrease healthcare cost. Early postoperative adverse events not only increase healthcare cost, but also illuminate areas of potential improvement in patient care. This study aims to delineate factors that may influence emergency department visits, admissions, and reoperations within 30 days of ankle fracture surgery. Methods: This retrospective review of patients at a Level 1 trauma center evaluated 30-day outcomes after ankle fracture surgery over a 4-year period (2015-2018). The outcome measures assessed were emergency department visits within 30 days, unplanned readmissions within 30 days and unplanned return to the operating room (OR) within 30 days. Patient and injury characteristics were investigated as potential factors related to these 30-day outcomes. Multiple linear regression was used for outcomes. P-values less than 0.05 were considered significant. Results: A total of 619 patients were identified. After exclusion of concurrent pilon fractures, 596 patients were eligible for final analysis. Forty-three (7.2%) patients visited the emergency department within thirty days, 30 (5.0%) patients were readmitted within thirty days, and 10 (1.7%) patients requiring unplanned return to the OR within thirty days. Sex, insurance status, comorbidities such as pulmonary disease, diabetes mellitus, psychiatric disease, and chronic kidney disease, smoking status, and fracture type/location were not found to be significantly related to 30-day events. Age less than 45 was a significant risk factor for returning to the ED within 30 days (RR 2.1, p=0.02). Open fractures were more likely to require unplanned reoperation than closed fractures (RR 5.7, p