Patients Have Different Pre-surgical Expectations for Foot and Ankle Procedures Than Their Surgeons

Two thirds of patients scheduled for foot or ankle surgery had higher pre-surgical expectations than their surgeons, according to a first-ever study comparing surgeon and patient expectations for the outcomes of various foot and ankle procedures.

The study, from researchers at the Hospital for Special Surgery (HSS), was scheduled for presentation at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS), canceled due to the COVID-19 pandemic. The abstract has been published online as part of the AAOS Virtual Education Experience.

“An in-depth understanding of what factors contribute to preoperative patient expectations is especially critical in foot and ankle surgeries, as there are a wide variety of surgeries in our subspecialty, each of which comes with different expectations,” said Scott J. Ellis, MD, a foot and ankle orthopedic surgeon at HSS and an author of the study.


RELATED: Save the date for the 11th Annual Current Solutions in Foot & Ankle Surgery, January 28-30 in Tampa, Florida


Patient expectations of orthopaedic procedures have been demonstrated to be strongly associated with clinical outcomes and postoperative satisfaction. While efforts to quantify the difference between patient and surgeon expectations have been undertaken in spine and total knee arthroplasty, among other subspecialties, few attempts have been made to measure this in foot and ankle surgery.

In reviewing the operative schedules of 7 foot and ankle surgeons at HSS, Dr. Ellis and his colleagues hypothesized that:

  • Patients would have greater expectations for their outcomes than their surgeons
  • There would be greater differences in preoperative expectations between patients and surgeons in major versus minor foot or ankle surgery
  • Greater differences between patient and surgeon expectations would be associated with worse preoperative physical and mental health

“Although most surgeons do their best to engage in open conversations with their patients about what they can expect from surgery, many find it difficult to tell patients that they are not going to be as good as new postoperatively,” Dr. Ellis said. “It is challenging to get patients past the belief that surgeons have a magic wand.”

Working with researchers from Weill Cornell Medicine, the HSS team examined data from 202 patients, administering a 23-item survey that assessed expectations regarding:

  • Pain
  • Physical function
  • Shoe wear
  • Appearance
  • Work
  • Social activity
  • Psychological factors

Surgeons were given the same survey and asked how much improvement they expected their patient to gain in those areas.

In addition, patients completed Patient-Rated Outcomes Measurement Information System (PROMIS) computer adaptive tests in Physical Function, Pain Interference, Pain Intensity, Depression and Global Health prior to their procedures.

“We determined that 66.3% of patients had higher expectations than their surgeons, 21.3% had concordant expectations, and 12.4% had lower expectations,” Dr. Ellis said.

“In addition, the study showed that the majority of patients who had worse preoperative PROMIS scores had higher postoperative expectations. We also found that depressed and anxious individuals had greater expectations than their surgeons, as did patients with a higher body mass index.”

Going forward, Dr. Ellis said that future research should delve into other potential factors such as medical literacy and patients’ knowledge of their condition, as well as the bond between surgeon and patient.

“Ideally, we could construct a study that could follow patients out to 1 or 2 years so as to determine amongst those whose expectations were met, how they were fulfilled,” he said. “In the meantime, we suggest that a preoperative educational class for foot and ankle patients would go a long way towards a rapprochement between patients and surgeons when it comes to expectations.”



Macmahon A, Cody E, Henry J, Drakos MC, Johnson AH, Demetracopoulos CA, Hummel A, Savenkov O, Ellis S. Comparison of Patients’ and Surgeons’ Expectations in Foot and Ankle Surgery. Paper 171. AAOS Virtual Education Experience.

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