Before undergoing surgery to correct progressive collapsing foot deformity (PCFD), most patients want to know: Will I be able to get back to doing the things I love?
With the findings of a new study from Hospital for Special Surgery (HSS), surgeons may now be able to answer that question by outlining attainable goals for return to sports and related physical activities.
The study results were presented at the 2022 Annual Meeting of the American Academy of Orthopaedic Surgeons.
“Is This Going to Be Worth It?”
“PCFD is a debilitating condition marked by several progressive deformities that require a combination of extensive reconstructive procedures, from cutting and reshaping bones in the foot to rerouting tendons in the fallen arch,” said Scott J. Ellis, MD, an orthopaedic foot and ankle surgeon at HSS and the senior researcher on the study.
“This procedure is the epitome of big surgery. It is associated with a long recovery period, and patients are quite immobile even before they reach the operating room. As a result, even surgeons want to know: Is this going to be worth it?”
He added that although patients can expect to eventually resume at least light to moderate physical activity, “the recovery period can take many months to a year or more, and some of the most vigorous sports may not be possible.”
The HSS study is the first attempt to quantify the recovery period for individual activities. The research team used the HSS Orthopaedic Foot and Ankle Registry to identify 82 patients, aged 18 to 60, who had undergone reconstructive foot surgery between February 2016 and May 2019. The average time since surgery was a mean of 3.1 years (range, 2 to 5.4 years).
The researchers contacted these patients and asked them to complete a questionnaire on their ability to return to 21 physical activities, such as yoga, biking, walking, and running, as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess the overall level of function, pain, and other clinical outcomes.
Patients said that 50% of the 21 activities had become easier for them to perform after surgery, 33% were no different, and 17% had become more challenging. Improvements in physical function (P=0.021), pain (P=0.001) and global physical health (P=0.001) were associated with statistically significant increases in patient satisfaction with respect to sports and physical activities.
No patients surveyed said they had stopped doing activities they had performed before surgery, but many said they had taken up new activities – mainly low-impact pursuits such as walking, biking, and swimming. Overall, 74 of the 82 patients (90%) reported being somewhat to very satisfied with their ability to be active, while just 8 (10%) said they were unsatisfied with the results of the surgery in that regard.
Returning to Activities
The most exciting part of the study, noted lead author Robert Fuller, was that the researchers were able to collect enough data on individual physical activities that they can now advise patients not only on the types of activities they can expect to carry out, but also on the length of time they can expect to be off their feet after surgery.
“We think this study gives us the ability to say to a patient, ‘If you’re interested in doing yoga again, you can expect to return in about 6 to 9 months and be back to full form in about a year,’” said Mr. Fuller, a clinical research scientist at HSS.
“It can help provide clarity for a lot of people, showing [that] these surgeries can be life-changing in terms of getting them active again, but [that] a substantial amount of people will face some extended recovery.”
Not surprisingly, Mr. Fuller said, patients who undergo foot reconstruction can resume low-impact activities faster than those who practice more demanding sports such as dancing, jogging, skiing, or basketball. However, “we observed great progress in both high- and low-impact activities,” he said.
Optimizing the Surgical Plan
Although the new research highlights the effectiveness of the reconstructive procedure, more work is needed to help standardize good outcomes for patients.
At HSS, Dr. Ellis and his colleagues are using new technologies such as weight-bearing CT scans to help identify which bones in the affected foot are collapsing and which ligaments are failing. This allows them to better understand the anatomy of the deformities and optimize the surgical plan.
They also are incorporating a computer modeling technique called finite element analysis to simulate how the foot will appear after the bones and other tissues are cut.
“We plan to use the data from this study to provide patients with realistic expectations and timelines regarding their return to sports activities after collapsing flatfoot reconstruction, and as a resource for patients at the time when surgery is being discussed,” Dr. Ellis concluded.
Fuller R, Eble SK, Day J, Cororaton AD, Rajan L, Ellis S. Return to Sports and Physical Activity following Flatfoot Reconstruction (Paper 040). Presented at the American Academy of Orthopaedic Surgeons’ 2022 Annual Meeting, March 22-26, 2022, Chicago, Illinois.