Pain, appearance improvements satisfy foot and ankle surgery patients

By Lynda Williams

Ongoing pain, appearance, choice of footwear, and impact of pain and function on social interaction are the main predictors for patient satisfaction following foot or ankle surgery, UK research indicates.

These factors accounted for 67% of variance in satisfaction among the 491 adults questioned an average of 9 months after their procedure, report Jill Dawson and co-workers, from the University of Oxford and Nuffield Orthopaedic Centre.

The patients were asked to complete the Manchester-Oxford foot questionnaire (MOXFQ), the Short Form (SF)-36 general health questionnaire, and the EQ-5D instrument for health outcomes before and after surgery.

Procedures were sited at the hallux (31.2%), lesser toe (17.7%), mid-foot (3.3%), ankle/hindfoot (46.5%), and multiple or whole foot (1.3%), and corrected a range of conditions, including hallux valgus, hallux rigidus, and ingrowing nails. The patients were aged an average of 52.8 years, 63.6% were female, and 7.5% underwent further surgery within the year.

At follow up, the majority (64.9%) of patients reported "no pain now/much better," 18.6% said "slightly better," and 7.3% reported "no change," while 9.2% of patients said their pain was "slightly" or "much" worse than before their operation.

Around half of patients (51.8%) were "very pleased" with their surgery outcome, 30.4% were "fairly pleased," 10.8% were "not very pleased," and 6.9% were "very disappointed."

After adjusting for age, gender, type of surgery, and other confounding factors, the likelihood of a patient being "very pleased" with their outcome was significantly influenced by the patient's perception of their foot or ankle appearance, the range of shoes that could be worn (odds ratio [OR]=0.36), continuing pain in their foot or ankle, and whether the patient had impairment on the MOXFQ social interaction scale.

Region of surgery was not a significant factor for satisfaction but the researchers note they were unable to account for recovery time between procedure types, and acknowledge that patients may take more than 9 months to recover from more extensive procedures, such as total ankle replacement.

Noting that their research confirms findings found in smaller groups of patients undergoing hallux valgus surgery, the team concludes in The Foot that the "results of the analysis described in this paper extends those findings to include other regions of the foot/ankle and incorporates the application of the only foot/ankle [patient reported outcome measure] to have been designed with patients and validated all within the foot/ankle surgical context."

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