Search

Introduction/Purpose: This study sought to establish normative values for baseline physical and mental health by foot and ankle diagnosis using validated Patient-Reported Outcomes Measurement Information System (PROMIS) scores and to compare the correlation between these two outcomes across common foot and ankle diagnoses. Additionally, it investigated the effect of specific foot and ankle diagnoses on self-reported mental health at first presentation. Methods: We retrospectively reviewed baseline PROMIS Physical Function Short Form 10a (PF10a) and PROMIS Global-Mental (PGM) scores of 14,374 patients who had one of the 10 most common foot and ankle diagnoses seen at our institution between 2016 and 2021. Pearson correlation coefficients were calculated to assess the relationship between PF10a and PGM by diagnosis. A multivariable regression model was also used to determine the effect of each diagnosis on PGM score. Results: On unadjusted analysis, patients diagnosed with an ankle fracture had the lowest mean physical function, while patients with hallux valgus had the highest (PF10a=33.9 vs 46.7). Patients with foot/ankle osteoarthritis had the worst mean self-reported mental health, while patients with hallux rigidus had the best (PGM=49.9 vs 53.4). PF10a and PGM scores were significantly positively correlated for all diagnoses; the correlation was strongest in patients diagnosed with foot/ankle osteoarthritis or hammertoes (r=0.511) and weakest in patients with ankle fractures (r=0.239) or ankle sprains (r=0.287). Chronic conditions, including hammertoes (β=-4.9, 95%CI [-5.6, -4.2], p< 0.001), foot/ankle osteoarthritis (β=-4.8, 95%CI [-5.5, -4.1], p< 0.001), and hallux valgus (β=-4.6, 95%CI [-5.3, -3.9], p< 0.001) were associated with the largest negative effects on patients’ self-reported mental health. Conclusion: Self-reported physical function and mental health varied across common foot and ankle diagnoses and were more tightly correlated in chronic than acute conditions. The effect of diagnosis on mental health scores appears to be worse for more chronic diagnoses, including those that are generally associated with relatively unimpaired physical function. Comparison of mean unadjusted PROMIS Physical Function 10a and PROMIS Global-Mental scores by diagnosis.

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is commonly treated with proximal or distal first metatarsal osteotomies. Despite good correction, these procedures bear inherent risks such as malunion, nonunion, metatarsal shortening, loss of fixation, and avascular necrosis (AVN). Suture button fixation has been used as another form of HV treatment that avoids the use of corrective osteotomies and maintains reduction of the intermetatarsal angle (IMA). The goal of this study was to assess the radiographic and functional outcomes of patients undergoing HV correction with a distal soft tissue procedure and proximal suture button fixation. Methods: Twenty-two patients underwent HV correction utilizing a distal soft tissue correction and proximal fixation with the Mini TightRope (Arthrex, Inc, Naples, Florida) device. The IMA, hallux valgus angle (HVA), and sesamoid station were measured on radiographs obtained preoperatively as well as in the immediate post-operative period and at final follow-up. Preoperative and postoperative Short Form-36 (SF-36) and Foot and Ankle Ability Measure (FAAM) scores were collected. Postoperative Visual Analog Scale (VAS) scores, complications, and any additional surgical procedures performed were also recorded. Results: Mean follow-up was 27.7 months.The mean preoperative IMA and HVA were 16.9 and 32.6 degrees.The mean immediate postoperative IMA was 5.2 degrees(p20degrees.All components of the FAAM and SF-36 showed improvement from preoperative to final follow-up, although these changes were not statistically significant.The average final postoperative VAS was11.05.Of the 22 cases, three experienced complications, including an intra-operative second metatarsal fracture, a postoperative second metatarsal stress fracture, and a postoperative deep vein thrombosis(DVT). Conclusion: The use of a distal soft tissue procedure in conjunction with proximal suture button fixation is a safe and effective procedure for treating symptomatic HV deformity. Our results show that this technique can correct the IMA, HVA, and sesamoid station without the need for osteotomy and with minimal risk of complications.

Category: Sports Introduction/Purpose: Peroneal tendinopathy is a common condition of the ankle and may lead to substantial pain and disability. Low lying peroneus brevis (PB) muscle belly, accessory tendons and bony abnormalities have been implicated in peroneal tendon pathology. To date, studies have reported the presence of these variants or the distal extent of a muscle belly with the presumption that this reflects an increased intra-sheath volume. The goal of this study was to perform volumetric measurements of MR images of peroneal tendons in patients with peroneal pathology requiring surgical intervention and those without. Methods: Two fellowship trained musculoskeletal radiologists evaluated MR images of patients with and without peroneal tendon pathology. The volume of the peroneal tendon sheath and its contents were measured from the level of the tibial plafond down to the peroneal tubercle. The volumes were measured using the Vital Images 3D Vitoria program. The program allows calculation of volumes based on selected area outlines on each axial slice and then compiles each slice into a stacked volume. The presence of a peroneus quartus (PQ), synovitis and peroneal tendon tears were also recorded. Results: Fifty-one patients with peroneal pathology and 15 control patients were included. The mean distance of the PB muscle belly to the tip of the fibula was 5.55 ± 2.5 mm and 11.79 ± 4.07 mm for the groups with and without pathology, respectively (p=0.017). The mean total sheath volume was 7.06 ± 0.95 cc and 5.12 ± 0.53 cc (p=0.001), respectively. The mean PB and PQ combined volume was 1.31 ± 0.29 and 0.86 ± 0.24 cc (p=0.023), respectively. In isolation, the peroneal muscle volume was 0.87 ± 0.25 cc and 0.80 ± 0.25 cc (p=0.733), respectively. Conclusion: The volume of the peroneal tendon sheath and its contents are greater in the patients with peroneal tendinopathy that required surgery compared to controls. Despite the lower position of the muscle belly in the peroneal tendinopathy group, which is similar to previous studies, this was not reflected in increased volumetric measurements. However, when the PQ tendon was included this combined volume was significantly greater. Volumetric measurements are a more accurate way to assess the peroneal sheath in patients with peroneal pathology.