Study provides achievable goals for return to sport after reconstructive foot surgery

Many patients who undergo surgery to correct a collapsing foot share the question: will I be able to go back to doing the things I love?

A new study by researchers at the Hospital for Special Surgery (HSS) in New York provides achievable goals for return to sports and related physical activities for patients who have undergone procedures to correct progressive foot deformity ( PCFD), a serious musculoskeletal condition that can significantly inhibit a patient’s daily function. The findings were presented today at the 2022 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS).

This procedure is the epitome of major surgery. It is associated with a long recovery period and patients are fairly still before they even reach the operating room. As a result, even surgeons want to know: will it be worth it?”

Scott J. Ellis, MD, orthopedic foot and ankle surgeon at HSS and study principal investigator

Dr Ellis added: “PCFD is a debilitating condition marked by several progressive deformities that require a combination of extensive reconstructive procedures, ranging from cutting and reshaping of foot bones to rerouting tendons in the fallen arch of the foot. Although patients can expect to eventually resume at least light to moderate physical activity, the recovery period may take several months to a year or more, and some of the more vigorous sports may not be possible.”

This study is the first attempt to quantify the recovery period for individual activities. The HSS research team, led by clinical researcher Robert Fuller, analyzed patient-reported data from 82 patients, ages 18 to 60, who had undergone reconstructive foot surgery at the hospital between February 2016 and May 2019. About three quarters of the patients were female, and the average time since surgery was about 3 years (range, 2 to 5.4 years).

Patients were asked about their ability to resume 21 physical activities, such as yoga, cycling, walking and running, as well as their general level of function, pain and other outcomes using the HSS Orthopedic Foot and Ankle Registry, a rich repository of data. that helps clinicians and researchers better guide treatment decisions.

According to the results, patients said half of the 21 activities became easier for them after surgery, while 33 percent felt no difference and 17 percent said the activities became more difficult. Improvements in physical function (P=0021), pain (P=0.001) and overall physical health (P=0.001) were associated with statistically significant increases in patient satisfaction with sports and physical activities.

No patient surveyed said they had stopped doing activities they had been doing before surgery, but many said they had resumed new activities, mostly low-impact activities such as walking, cycling and swimming. . Overall, 74 of 82 patients (90%) said they were somewhat to very satisfied with their ability to be active, while only eight (10%) said they were not satisfied with the results of surgery in this regard.

The most exciting part of the study, Fuller said, is that the researchers were able to collect enough data on individual physical activities to now be able to advise patients on not just the types of activities they can expect to be carried out, but also over time. how long they can expect to lose footing after surgery.

“We believe this study gives us the ability to tell a patient, ‘If you’re interested in doing yoga again, you can expect to be back in about six to nine months and be back to full fitness in about a year.'” Fuller said. “It may help clarify the situation for many people by showing that these surgeries can be life-changing by making them active again, but a significant number of people will face a prolonged recovery.” Indeed, the researchers found that 22% of patients said they never reached their preoperative maximum level of participation in physical activities, and 26% said that their difficulty in performing activities increased after surgery. .

Unsurprisingly, Fuller said, people who undergo foot reconstruction can return to low-impact activities — faster than those who engage in more demanding sports like dancing, jogging, skiing or basketball. However, “we have seen great progress in both high and low impact activities,” he added.

Although the new research highlights the effectiveness of the reconstructive procedure, Fuller and Dr. Ellis said more work is needed to help normalize good outcomes for patients. At HSS, Dr. Ellis and his colleagues are using new technologies such as weight-bearing CT scans to help identify collapsing affected foot bones and failing ligaments to better understand the anatomy of deformities and optimize the surgical plan. They also incorporate a computer modeling technique called finite element analysis to simulate how the foot will look after cutting bones and other tissues.

“We plan to use the data from this study to provide patients with realistic expectations and timelines for their return to athletic activities after flatfoot reconstruction collapses, and as a resource for patients as surgery is under discussion,” Dr. Ellis concluded.


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