Foot & Ankle Orthopaedics最新文献

{"title":"Standing on the Heels of Giants: A Historical Perspective of Eponyms for Calcaneal Osteotomies.","authors":"Thelma R Jimenez Mosquea, Andrew S Bi, Nina D Fisher, Hugo A Ubillus, Raymond J Walls","doi":"10.1177/24730114241300151","DOIUrl":"10.1177/24730114241300151","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241300151"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormonal Fluctuation and Ankle Instability in Women-Is There a Correlation?","authors":"Hayden Hartman, Shannon Fehr, Arianna L Gianakos","doi":"10.1177/24730114241300140","DOIUrl":"10.1177/24730114241300140","url":null,"abstract":"<p><strong>Background: </strong>With higher incidences of ankle sprains and chronic ankle instability in women, it has been postulated that hormonal modulation and ligamentous laxity influences injury propensity. The purpose of this study is to investigate the impact of hormonal fluctuation on ankle stability and ligamentous laxity and their potential contribution to injury propensity in the female athlete.</p><p><strong>Methods: </strong>In November 2023, a systematic review of the MEDLINE, Embase, and Cochrane Library databases was performed following PRISMA guidelines. Articles were included if they were published after the year 2000, evaluated outcomes related to the impact of hormones on ankle stability in healthy patients, and included menstrual tracking. The following search terms were used: \"(sex or gender) AND (ankle stability)\" and \"(hormone) AND (ankle).\"</p><p><strong>Results: </strong>Thirteen articles were included, with 253 (76.4%) women at a weighted mean age of 21.9 ± 2.0 years (range, 20.0-25.9). Five studies evaluated postural sway and balance noting greater sway rates during ovulation compared with the follicular phase. Greater muscle tone (<i>P</i> < .001) was observed in the follicular phase than ovulation for the tibialis anterior, peroneus longus, and lateral gastrocnemius. Significantly higher ankle joint laxity was observed in ovulation (<i>P</i> = .016).</p><p><strong>Conclusion: </strong>This review found that during ovulation, when estrogen peaks, subjects showed impaired balance with higher postural sway rates, greater ankle joint laxity, and decreased muscle and ligamentous tone and stiffness-an indicator of laxity. An underlying hormonally mediated etiology for the increased propensity to ankle instability in the female athlete is suggested. Syncing an athlete's workout type and intensity around menstrual cycle phase may be an advantageous strategy for injury prevention.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241300140"},"PeriodicalIF":0.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keller and Interphalangeal Joint Resection Arthroplasties for Chronic Noncomplicated Diabetic Ulcers of the Hallux: A Systematic Review and Meta-analysis.","authors":"Kaissar Yammine, Joseph Mouawad, Mohammad Omar Honeine, Chahine Assi","doi":"10.1177/24730114241300139","DOIUrl":"10.1177/24730114241300139","url":null,"abstract":"<p><strong>Background: </strong>Surgery is often needed for resistant plantar diabetic foot ulcers (DFUs) of the big toe. For noninfected ulcers, 2 types of surgery are available: the Keller and the hallux interphalangeal joint arthroplasty (HIPJ-A) procedures. Yet, no evidence synthesis on the outcomes of these procedures has been conducted; thus, this systematic review is an attempt to fill this gap.</p><p><strong>Methods: </strong>Only studies reporting the results of Keller (or its variants) and HIPJ-A (or its variants) procedures for noncomplicated ulcers (Texas 1A/2A, or Wagner I/II) were included. Ulcers located beneath the metatarsal head were excluded. Ultimately, 11 studies were selected for inclusion and were analyzed. The primary outcome was defined as the ulcer healing frequency. The secondary outcomes were mean healing time, ulcer recurrence frequency, ulcer transfer frequency, postoperative infection rate, and revision surgery rate.</p><p><strong>Results: </strong>The overall (combined techniques) weighted healing rate was 94% with a mean healing time of 3.1 ± 0.4 weeks. The ulcer recurrence frequency was 6%, the ulcer transfer frequency 4.5%, the postoperative infection rate 18%, and the revision surgery rate 3.8%. No significant differences were found between both techniques. When compared to standard of care, the odds ratio of ulcer healing frequency was 27.1 (95% CI 1.442-508.174, <i>P</i> = .01) in favor of the Keller arthroplasty with a faster healing time (<i>P</i> = .02).</p><p><strong>Conclusion: </strong>Both surgical offloading procedures are highly effective in treating chronic noncomplicated DFU of the plantar aspect of the hallux along with low complication frequencies. There is a need to fine-tune the indication in relation to the location of the plantar wound with future comparative controlled research studies with far more patients than we could include in this meta-analysis.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241300139"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fragility of Statistically Significant Binary Outcomes for Treating Achilles Tendinopathy: A Systematic Review of Randomized Trials.","authors":"Omkar S Anaspure, Shiv Patel, Anthony N Baumann, Andrew Newsom, Albert T Anastasio, Annunziato Amendola","doi":"10.1177/24730114241300160","DOIUrl":"10.1177/24730114241300160","url":null,"abstract":"<p><strong>Background: </strong>Randomized controlled trials (RCTs) are the gold standard for treatment efficacy, but foot and ankle RCTs are often small or inconsistent. The Fragility Index (FI) evaluates the stability of significant findings. This study assessed the fragility of RCT outcomes for Achilles tendon pathology (ATP) interventions.</p><p><strong>Methods: </strong>This systematic review queried PubMed up to May 14, 2024, for RCTs on ATP interventions. RCTs with significant binary outcomes were included. Two reviewers assessed eligibility, extracted data, calculated FIs, and evaluated risk of bias. Frequency-weighted means were used for narrative synthesis.</p><p><strong>Results: </strong>Eleven RCTs with 4506 patients (mean cohort size: 409.64 ± 160.54) and a mean age of 36.97 ± 13.51 years (n = 4356; 96.67%) were included, covering 24 binary outcomes. The median FI across all outcomes was 3 (interquartile range 1-4; mean 3.92), indicating that changing the outcome of just a few patients could shift a study's results from statistically significant to nonsignificant. Trials having an FI ≤3 comprised 58.33%. Three outcomes (12.5%) had an FI of zero after recalculating <i>P</i> values using the two-sided Fisher exact test. Half of the outcomes were robust. No RCT reported FIs or adjusted significance for multiple testing. Most studies (81.82%) performed 2 or more statistical tests, with an average of 30.81 ± 41.28 <i>P</i> values reported per study. The overall risk of bias was low in 1 study (9.09%) and moderate in 7 (63.64%). Most studies had low risk of bias in randomization (72.73%) and missing outcome data (90.91%).</p><p><strong>Conclusion: </strong>The FI assesses the fragility of statistically significant binary results, revealing that many ATP RCTs have fragile outcomes due to small sample sizes. A median FI of 3 means that changing the outcome of 3 patients could shift a study's results from statistically significant to nonsignificant.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241300160"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Subjective Features and Physical Examination Tests for Morton Neuroma: A Systematic Review.","authors":"Mark Pitcher, Andrea Moulson, David Pitcher, Anthony Herbland, Grad Cert, Mindy C Cairns","doi":"10.1177/24730114241291055","DOIUrl":"10.1177/24730114241291055","url":null,"abstract":"<p><strong>Background: </strong>Morton neuroma (MN) is a common pathology with many reported subjective features and physical examination tests. The objective of this systematic review was to examine the diagnostic accuracy of subjective features and physical examination tests for MN.</p><p><strong>Methods: </strong>CINAHL, CENTRAL, EMBASE, MEDLINE, PubMed, Opengrey, PEDro, PsycINFO, Scopus and Trials register were searched in January 2021. Two reviewers independently screened studies for inclusion using the following criteria: (1) prospective or retrospective cohort studies, (2) participants aged ≥18 years with suspected MN, (3) primary data allowing construction of 2 × 2 diagnostic table or reported sensitivity and specificity figures, (4) diagnosis of MN using magnetic resonance imaging, ultrasonography, surgery, positive response to steroid and/or anesthetic injection, and (5) in English or translatable. Quality of included studies was assessed using the Quality Assessment for Diagnostic Accuracy Studies version-2 (QUADAS-2) tool.</p><p><strong>Results: </strong>The search yielded 1170 results, of which 9 were included in this systematic review. Narrative synthesis revealed that subjective clicking reported by a patient was highly specific (0.96) and had a high positive likelihood ratio (13.14). The modified webspace tenderness test (thumb index finger squeeze test) was highly sensitive (0.96) with a low negative likelihood ratio (0.04). The commonly reported feeling of \"walking on a pebble\" and \"burning pain\" had sensitivities of 43% to 53% and 54% to 57% and associated specificities of 52% and 48%, respectively.Only 1 study had low risk of bias. The review was limited by the number of studies that included few or no patients without MN, and the impact this had on the ability to calculate diagnostic accuracy.</p><p><strong>Conclusion: </strong>There is strong evidence that clicking reported by a patient rules in MN and that the modified webspace tenderness test rules out MN when negative.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241291055"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Case Series of Single-Screw vs Dual-Screw Fixation for Treatment of Medial Malleolus Fractures.","authors":"Junaid Aamir, Robyn Caldwell, Sarah Long, Sachith Sreenivasan, Jason Mavrotas, Ayn Panesa, Shagilan Jeevaresan, Vasileios Lampridis, Lyndon Mason","doi":"10.1177/24730114241291064","DOIUrl":"https://doi.org/10.1177/24730114241291064","url":null,"abstract":"<p><strong>Background: </strong>Medial malleolus fractures (MMFs) are common across the world. Currently, there is a lack of consensus on the number of screws used in fixation of MMF. Our aim was to compare the radiographic outcomes of MMF with patients between fractures that have either undergone single-screw (SS) or dual-screw (DS) fixation.</p><p><strong>Methods: </strong>This retrospective study assessed patients who had undergone fixation of their MMF from 2012 to 2022. Analysis of their perioperative radiographs was performed to determine the initial type of injury and then radiographic outcomes of nonunion and malunion.</p><p><strong>Results: </strong>A total of 653 patients suffering bimalleolar fractures were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 in the DS group (58.50%). There was no difference found in the nonunion rate of SS (19.19% [52 of 271]) compared with DS (18.85% [72 of 382]) (<i>P</i> = .931). A statistically significant difference between malunion rates was found between the SS group (11.07% [30 of 271]) compared with the DS group (3.93% [15 of 382]) (<i>P</i> < .001).On multiregression analysis, factors that gained significance for development of nonunion was nonfixation of syndesmosis (<i>P</i> = .039), ankle dislocation on arrival (<i>P</i> < .001), and nonrestoration of fibular length (<i>P</i> < .001). Other factors that showed significance for failure to achieve medial anatomical reduction was nonfixation of syndesmosis (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Use of an SS rather than DS showed a significant increase in nonanatomical reduction but did not increase nonunion or reoperation rate. Syndesmosis fixation was associated with higher rates of MMF nonunion and malunion; as such, surgeons should have a low index of suspicion of injury and fixation.</p><p><strong>Level of evidence: </strong>Level III, retrospective case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241291064"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D Analysis of Metatarsal Torsion by Computed Tomography in Normal, Hallux Valgus, and Hallux Rigidus Feet.","authors":"Tadashi Kimura, Makoto Kubota, Takumi Kihara, Naoki Suzuki, Asaki Hattori, Mitsuru Saito","doi":"10.1177/24730114241294074","DOIUrl":"https://doi.org/10.1177/24730114241294074","url":null,"abstract":"<p><strong>Background: </strong>One factor contributing to rotational deformity of the first metatarsal in hallux valgus is torsion of the metatarsal itself. Hallux rigidus also involves reduction of the longitudinal arch, but metatarsal torsion has not been discussed. We hypothesized that metatarsal torsion may be a morphologic change unique to hallux valgus. We compared 3-dimensional (3D) torsion of the first to fifth metatarsals between feet with hallux valgus, feet with hallux rigidus, and healthy control feet to investigate differences in the effects on pathologic conditions.</p><p><strong>Methods: </strong>Participants were women of East Asian descent. There were 16, 16, and 14 feet in the control, hallux valgus, and hallux rigidus groups, respectively. One randomly selected control foot was designated as the reference foot. For comparison, nonweightbearing computed tomography images of the metatarsals were reconstructed in 3D, and the proximal and distal areas were superimposed on the reference foot. Torsion angle was defined as the rotational angle of the distal part of the articular axis relative to the proximal area. In the hallux valgus group, correlations of torsion angle with hallux valgus angle and intermetatarsal angle were calculated.</p><p><strong>Results: </strong>The hallux valgus group had greater average pronation torsion in the first metatarsal than the control group and hallux rigidus group (11 and 13 degrees greater, respectively, <i>P</i> < .01). No significant differences were observed for the second to fifth metatarsals (<i>P</i> > .05). There was no significant correlation with hallux valgus angle or first-second intermetatarsal angle in the hallux valgus group (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>Hallux valgus feet had pronation deformities in the first metatarsals not observed in control or hallux rigidus feet, meaning that torsion toward pronation (eversion) in the first metatarsal was unique to hallux valgus. Improved surgical correction to diminish pronation may be necessary in patients with hallux valgus patients because of first metatarsal pronation in the first tarsometatarsal to normalize mechanical first-ray alignment.<b>Level of Evidence</b>: Level III, case-control stud.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241294074"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes After Total Ankle Arthroplasty: A Systematic Review.","authors":"Michael S Lee, Lucas Mathson, Clark Andrews, Dylan Wiese, Jessica M Fritz, Andrew E Jimenez, Brian Law","doi":"10.1177/24730114241294073","DOIUrl":"https://doi.org/10.1177/24730114241294073","url":null,"abstract":"<p><strong>Background: </strong>Total ankle arthroplasty has emerged as a treatment to successfully treat ankle arthritis. Recent studies have reported more than 40 000 total ankle arthroplasties (TAAs) being performed between 2009 and 2019 in the United States. Although recent studies have reported favorable patient-reported outcomes at short- and midterm follow-up, there is a paucity of aggregate literature reporting on long-term patient-reported outcomes (PROs) after TAA. The purpose of this review is to report an aggregate of literature on minimum 10-year patient-reported outcomes after TAA.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were queried in June 2024. Primary research articles were included if they reported minimum 10-year PROs or satisfaction for patients who underwent primary TAA and were written in English. Survivorship was reported based on implant failure, which was determined uniquely by each study.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria. A total of 595 ankles with a range of average ages from 51 to 73.7 years were included in the study with follow-up ranging from a minimum of 10 years to a minimum of 20 years. Six of the 8 studies reported average follow-up ranging from 11.9 to 15.8 years. Two of the 8 studies reported significant improvement in PROs following surgery. Survivorship at a minimum of 10-year follow-up ranged from 66% to 94.4%. Average time to implant failure ranged from 4.6 to 13.8 years.</p><p><strong>Conclusion: </strong>Patients undergoing primary TAA were reported to have generally improved PROs at minimum 10- year follow-up. However, they demonstrated variable rates of survivorship ranging from 66% to 94.4%. Of those experiencing implant failure, average time to failure ranged from 4.6 to 13.8 years. Survivorship should be interpreted with caution because of varying definitions between studies. Further studies should seek to standardize the definition of survivorship and reporting of PROs to allow for effective analysis of heterogeneity.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241294073"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction Quality in Posterior Malleolar Fractures Using a Modified Posteromedial Ankle Approach.","authors":"Felipe Pino, Leonardo Lagos, Christian Urbina, Fernando Vargas, Mauricio Parra, Francisco Bravo, Christian Bastias","doi":"10.1177/24730114241290201","DOIUrl":"10.1177/24730114241290201","url":null,"abstract":"<p><strong>Background: </strong>Anatomical reduction of posterior malleolar fracture is a key goal in achieving good functional outcomes in patients with ankle fractures. Although there are many approaches for managing this type of fracture, no studies have shown reduction quality of posterior malleolar fracture in postoperative CT scan using the modified posteromedial ankle approach.</p><p><strong>Methods: </strong>A retrospective case series of 66 patients of 2 health centers with type 2, 3, and 4 posterior malleolar fractures according to Bartonicek classification treated using the modified posteromedial ankle approach was performed. The postoperative CT scan was used to assess syndesmotic reduction and articular step-off and residual gap in posterior malleolus reduction.</p><p><strong>Results: </strong>Reduction of posterior malleolus fracture was determined to be <2 mm in 62 patients and >2 mm in 4 cases. Syndesmotic reduction quality was considered to be anatomical in 61 patients. Four patients showed mild anterior fibular translation in the axial plane and were not reoperated. One syndesmotic malreduction was considered poor.</p><p><strong>Conclusion: </strong>In this study, we found that 92% (61 of 66) of patients with posterior malleolar fracture were reduced with <2 mm step-off using this modified posteromedial ankle approach and fracture fixation strategy.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241290201"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Social Deprivation on Patient-Reported Outcomes in Foot and Ankle Patients.","authors":"Kade Wagers, Blessing Ofori-Atta, Angela Presson, Devon Nixon","doi":"10.1177/24730114241290202","DOIUrl":"10.1177/24730114241290202","url":null,"abstract":"<p><strong>Background: </strong>The impact of social health on patient-reported outcomes (PROs) is gaining increasing attention within the orthopaedic community. Few studies have explored any relationship between social deprivation levels and PROs in orthopaedic foot and ankle patients.</p><p><strong>Methods: </strong>We retrospectively identified patients who presented to an orthopaedic foot and ankle clinic for new evaluation. Patients completed PROs including PROMIS physical function (PF), PROMIS pain interference (PI), and the Foot and Ankle Ability Measure (FAAM). Social deprivation was measured using the Area Deprivation Index (ADI), a metric that incorporates various domains of poverty, education, housing, and employment. The ADI score quantifies the degree of social deprivation based on the 9-digit home zip code but is not a specific measure to an individual patient. Briefly, a lower ADI indicates less deprivation whereas a higher score denotes greater deprivation. Patient characteristics and outcomes were summarized and stratified by the nationally defined median ADI. Multivariable linear regression models assessed the relationships between PROs and continuous ADI controlling for demographics (age, sex, race/ethnicity, marital status, and employment status).</p><p><strong>Results: </strong>Our cohort consisted of 1565 patients with PRO and appropriate zip code data. Patients in the most-deprived median ADI split had more pain (median PROMIS-PI 62.7 vs 61.2, <i>P</i> = .001) and less function (median PROMIS-PF 37.1 vs 38.6, <i>P</i> = .021) compared with the least-deprived median ADI split. The clinical significance of these findings is unclear, though, given the minimal differences between groups for PROMIS measures. There was no relationship between ADI and FAAM scores.</p><p><strong>Conclusion: </strong>More socially deprived patients presented to the clinic with marginally less function and greater pain. Although statistically significant, the clinical significance of these relationships is unclear and merits further exploration. We plan to continue to study the connection between social deprivation and patient outcomes in specific clinical conditions as well as before/after surgical interventions.</p><p><strong>Level of evidence: </strong>Level IV, retrospective cases series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"9 4","pages":"24730114241290202"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11492186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}