Shape of Foot May Predict Post-Surgery Outcome

Patients with moderate to severe ankle arthritis who are treated surgically for ankle instability secondary to multiple sprains as well as a high-arched (cavus) foot may have poorer outcomes over the long-term than patients with no or minimal ankle arthritis.

These findings are part of a study published in the journal Foot & Ankle International, which is the official scientific journal of the American Orthopaedic Foot & Ankle Society (AOFAS).

The study suggests that orthopaedic surgeons take a cautious, realistic approach when recommending surgical treatment options for this set of patients.

Ankle sprains are a common orthopeedic injury but when multiple sprains over time lead to instability, ankle arthritis may occur if left untreated. This condition is especially prevalent in patients with cavus foot deformity (present in 24% of the population).

Todd Irwin, MD, lead author of the study and an active AOFAS member said, in a press release. "There are excellent treatment options for patients who have both chronic ankle instability and high arched feet. However, if this combination has led to significant ankle pain and arthritis as seen on x-rays, there should be a discussion with the treating physician regarding the most appropriate surgical option. Our study shows that with longer term follow-up compared to previous studies, if the arthritis has reached a certain level of significance it is unlikely to improve and very likely to worsen despite surgery to stabilize the ankle and correct the foot deformity."

The five-year study looked at the effect varying levels of ankle arthritis had on the clinical outcomes of 22 patients who had undergone lateral ankle ligament reconstruction and corrective osteotomy for cavovarus deformity.

Two patient groups were established, those with no to minimal pre-operative ankle arthritis (Group 1) and those with moderate to severe pre-operative ankle arthritis (Group 2).

At a five-year follow-up, the clinical results revealed significant ankle arthritis progression in the majority of patients in Group 2 with no significant progression among patients in Group 1. Post operative pain levels were lower in Group 1 and overall satisfaction rate was higher in Group 1 than in participants in Group 2.

The findings are noteworthy for patients with the combination of high arched feet, ankle instability, and ankle pain, and their orthopaedic surgeons who must determine if a more extensive surgical procedure to treat the ankle arthritis, such as ankle fusion or ankle replacement, might be considered as a first alternative.

Source: American Orthopaedic Foot & Ankle Society--How may the findings affect the future practice of orthopaedic medicine?

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