Practice Patterns and Outcomes of Care for Patients with Common Foot and Ankle Disorders

Anna G. Chartrand, Jennifer L. Gunlikson, Katie C. Hopkins, Jamie R. King,

Katie E. Reinhart, Larissa C. Rodrigues, J. Timothy Noteboom, PT, PhD
School of Physical Therapy, Regis University, Denver, CO

INTRODUCTION RESULTS Mean Change in NPRS by Diagnosis DISCUSSION:

The rehabilitation process for foot and ankle
disorders is challenging. Controversy exists
regarding effectiveness of therapeutic approaches
for various lower leg, foot and ankle disorders. There
is limited research regarding optimal outcome
• Total Subjects: 89 (Female= 51; Male=38)
• Average age: 41.9 years
• Average Number of Visits: 8.8 visits
• Average Duration of Symptoms: 72.9 days
7
The majority of patients in this clinical study
6 experienced a significant improvement in function and
reduction in pain following a course of physical
5
therapy care. The mean NPRS and FAAM-ADL
scores were significantly different at end of care

NPRS
4

measures and evidence based interventions used to
manage ankle/foot disorders1.
We examined the diagnoses student physical
therapists identified in the clinic and determined
which interventions were implemented. We wanted
to identify if these interventions correlated to the
most current evidence.
Purpose:
The purpose of this analysis of practice was to
identify the most frequently encountered foot
and ankle disorders as well as to determine the
most commonly used physical therapy
compared to baseline, with a mean change of 3.2 for
• Sixteen percent of patients presented with co- 3 NPRS and 16.4 for FAAM-ADL. Using the MCID
morbidities, 84% did not. values to dichotomize patients into Success vs Non-
2 MCID = 2
success group indicated that 56% of patients had a
• Most Common Diagnoses:
1 successful outcome.
• Plantar Fasciitis (n=41)
0 The outcomes in this study are comparable to those
• Inversion Ankle Sprain (n=13) Plantar Fasc. Ankle Sprain Post-op Overall by Whitman et al3 who reported a 75% success rate
for acute ankle sprain patients receiving thrust and
• Post Surgical (n=20)
Mean Change in FAAM-ADL by Diagnosis non-thrust mobilizations and exercise, and who had
• 46 patients were classified as Success and 50
mean NPRS (2.0) and FAAM-ADL (18.1) change
35 patients as Non-success scores following two PT sessions.
• There was no effect of sex or presence of co- 40

interventions for these disorders. morbidity on Success vs. Non-success groups

CLINICAL RELEVANCE

FAAM-ADL
30
METHODS • The mean number of visits differed by diagnosis
but not by Success vs Non-success group
20
• Monitoring patient demographic data, outcome
• Data collected by student physical therapists on 4 measures and prioritized interventions can inform
clinical affiliations at multi-center clinics on pts with clinical practice.
8 different foot and ankle diagnoses. Mean Change from Baseline 10 MCID = 10
Outcome Measures • The use of both the FAAM and NPRS is warranted for
to End of Care
measuring clinical success.
• Data collection included: Dorsiflexion PROM 6.3 degrees 0
• No agreement exists concerning the cut-off scores
Plantar Fasc. Ankle Sprain Post-op Overall
• Initial and final Foot and Ankle Ability Measure used to determine successful outcomes. Most clinical
• Activities of Daily Living score (FAAM ADL)2 1st MTP Extension PROM 8.5 degrees
Diagnosis # of Visits Success Non-success prediction rules have used a 50% as the cut-off value
• Ankle dorsiflexion range of motion (ROM) NPRS at Worst 3.2 points and this could be used in future studies in this area.
• Numeric Pain Rating Scale (NPRS) Plantar
6.7 + 3.7 68% 32%
FAAM ADL 15.3 percent Fasciitis/osis
• 1st metatarsal phalangeal joint (MTP) extension
ROM Ankle Sprain 8.0 + 5.0 92% 8% References:
Post Surgical 16.6 + 22.8 40% 60%
• Patients classified as successful if they exceeded Diagnosis
#1 #2 #3 1. McPoil TG, RL Martin, MW Cornwall, et al. Heel pain-plantar
the Minimal Clinically Important Difference (MCID) Intervention Intervention Intervention fasciitis: Clinical Practice Guidelines. JOSPT. 2008;38(4):
for both primary outcome measures: A1-18.
Plantar Patient Muscle Soft-Tissue • The FAAM and NPRS scores were moderately 2. Martin R. Evidence of validity for the foot and ankle ability
• NPRS > 2 point decrease measure (FAAM). American Orthopaedic Foot and Ankle
Fasciitis/osis Education Stretching Mobilization inversely correlated (r = -.59). There was low
• FAAM ADL > 10 point increase Society. 2005;26(10):979.
correlation with ROM measures ( r = .05 - .32)
Patient Joint Strengthening 3. Whitman JM. Predicting Short-Term Response to Thrust and
• Data was coded and statistically analyzed with Ankle Sprain • Mean number of visits: Nonthrust Manipulation and Exercise in Patients Post
Education Mobilization Exercises
SPSS 17.0 version primarily consisting of Inversion Ankle Sprain. JOSPT. 2009;39(3):188-200.
• Success: 10.1 + 17.8 visits
descriptive and correlational statistics Patient Muscle Strengthening
Post Surgical
Education Stretching Exercises • Non-success: 8.7+ 4.5 visits
• Statistical significance set at p<.05