Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery.

OBJECTIVES: To ascertain the smallest amounts of change for the three Manchester-Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36). STUDY DESIGN AND SETTING: A prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery. RESULTS: Four hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ~13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC90) values for the MOXFQ were ~11, ~12, and ~16 score points for the W/S, Pain, and S-I scales, respectively. CONCLUSION: This article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery.

Factors associated with patient satisfaction with foot and ankle surgery in a large prospective study.

BACKGROUND: There is minimal published research on outcomes and satisfaction with foot and ankle surgery. OBJECTIVE: To investigate patient-reported outcomes and satisfaction, and investigate which factors influence satisfaction at 9 months following foot or ankle surgery. METHODS: Prospective study of 671 adult patients having foot or ankle surgery. Pre-and post-surgery, patients self-completed MOXFQ, SF-36 and EQ-5D questionnaires. Using ratings to a satisfaction item, patients who were 'very pleased' with the outcome were compared with everyone else, using multiple logistic regression, regarding their pre-, peri- and post-operative characteristics. RESULTS: Of 628 eligible patients, 491 (73%) completed pre-and post-operative questionnaires. Following adjustment, satisfaction with surgery was influenced by patients' perceptions of their foot/ankle's appearance (OR 0.12, 95% CIs 0.06-0.23, p<0.001); wearable range of shoes (OR 0.36, 95% CIs 0.17-0.79, p=0.01); continued foot/ankle pain (OR 0.06, 95% CIs 0.03-0.14, p<0.001); impairment in Social-Interaction (MOXFQ SI scale) (OR 0.98, 95% CIs 0.96-0.99, p=0.009). The final explanatory model explained 67% of the variance in patient satisfaction. CONCLUSIONS: Foot appearance, wearable shoe range, the (full) alleviation of pain and the ability/confidence to interact socially are crucial to peoples' satisfaction with their foot or ankle surgery.

A scoring system for the foot and ankle that is acceptable, reliable, valid and responsive.

We read with interest the recent paper by Groarke et al. (Quality of life in individuals with chronic foot conditions: a cross sectional observational study. The Foot (2012) doi:10.1016/i.foot.2011.11.007). The paper ended by stating that 'there is no scoring system for the foot and ankle that is valid, repeatable and reliable'. This statement is misleading. The authors could have made reference to the patient-reported Manchester-Oxford Foot Questionnaire (MOXFQ). The MOXFQ has been subjected to more rigorous testing of its measurement properties than is the case for most instruments, and has been demonstrated to be acceptable, reliable, valid and responsive in the context of foot or ankle surgery.

A year of foot and ankle orthotic provision for adults: prospective consultations data, with patient satisfaction survey.

OBJECTIVES: To characterise 12 months' adult, foot and ankle orthotic out-patient consultations in a regional centre; and to survey patients regarding their satisfaction with services received. METHODS: Prospective survey questionnaires completed by: (1) orthotists, during consecutive clinic consultations (n=4402 representing 2494 patients); (2) all patients receiving foot or ankle orthoses (n=1469), mailed 5 weeks later. Questions included a standard foot pain item, patients' perceived usefulness of the orthosis, and satisfaction with services received. Logistic regression identified factors associated with patients finding their orthosis 'very' or 'fairly helpful'. RESULTS: Consultations addressed myriad foot, ankle or other conditions. EVA (soft) foot orthoses were most commonly prescribed. The response rate from patients was 72%. Most (73%) said their orthosis would be 'very' or 'fairly helpful'. Following adjustment, females were less likely than males to find orthoses helpful (OR 0.71, p=0.031). All older age groups were at least twice as likely to find orthoses helpful as patients aged <40 (p<0.01). Ninety percent of respondents were 'very' or 'fairly satisfied' with the service received. CONCLUSIONS: Women, younger patients and those with more severe pain were less likely to perceive benefit from foot and ankle orthoses than other groups and may therefore require adjuvant or alternative intervention.

A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

BACKGROUND: A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. METHODS: We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. CONCLUSIONS: The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

The prevalence of foot problems in older women: a cause for concern.

BACKGROUND: Painful feet are an extremely common problem amongst older women. Such problems increase the risk of falls and hamper mobility. The aetiology of painful and deformed feet is poorly understood. METHODS: Data were obtained during a pilot case-control study about past high heel usage in women, in relation to osteoarthritis of the knee. A total of 127 women aged 50-70 were interviewed (31 cases, 96 controls); case-control sets were matched for age. The following information was obtained about footwear: (1) age when first wore shoes with heels 1, 2 and 3 inches high; (2) height of heels worn for work; (3) maximum height of heels worn regularly for work, going out socially and for dancing, in 10-year age bands. Information about work-related activities and lifetime occupational history was gathered using a Life-Grid. The interview included a foot inspection. RESULTS: Foot problems, particularly foot arthritis, affected considerably more cases than controls (45 per cent versus 16 per cent, p = 0.001) and was considered a confounder. Cases were therefore excluded from subsequent analyses. Amongst controls, the prevalence of any foot problems was very high (83 per cent). All women had regularly worn one inch heels and few (8 per cent) had never worn 2 inch heels. Foot problems were significantly associated with a history of wearing relatively lower heels. Few work activities were related to foot problems; regular lifting was associated with foot pain (p = 0.03). CONCLUSION: Most women in this age-group have been exposed to high-heeled shoes over many years, making aetiological research difficult in this area. Foot pain and deformities are widespread. The relationship between footwear, occupational activities and foot problems is a complex one that deserves considerably more research.