There are numerous ankle and hindfoot scores in existence, which have been devised and used to assess surgical interventions. All have in common that there has been little or no work done to demonstrate their validity, reliability or sensitivity to change. Which score one chooses to use for the assessment of outcome will at present depend largely on personal preference. We have undertaken a study to assess four of the most commonly used scores, those of Mazur (1978), Takakura (1990), AOFAS (1994) and Kofoed (1995) as well as a little used but well designed score, The Foot Function Index (1991). A cohort of twenty patients who had undergone a unilateral total ankle replacement (STAR) for rheumatoid or osteoarthritis were assessed by a single observer. The time following operation ranged from six to 48 months. All completed the above scores as well as a SF36 questionnaire. Using the SF36 as a “Gold standard” the scores were compared, both in terms of their overall results and also more specifically in terms of subsections such as pain and function. Our results, though not to be interpreted as validation, do give some rational basis for the choice of score to use in assessing total ankle replacements.
Injury to the dorsomedial cutaneous nerve has been identified as a potentially frequent occurrence after hallux valgus surgery. The existence of pre-operative pressure neuropathy is also described but remains largely unexplored. This study was performed to investigate the incidence of pre-operative sensory deficit in the hallux valgus toe, and to examine to what extent any deficit was related to the degree of joint angulation. A cohort of 43 patients (61 hallux toes) presenting for consideration of surgical correction had their sensation tested in pre-designated sensory zones using a five-filament set of Semmes-Weinstein monofilaments. These allowed good inter-observer reliability with an ICC (intra-class correlation coefficient) of 0.84 overall. Whilst sensory symptoms were self reported in only 21% of the feet, a measurable reduction in sensation by one monofilament grade or more was found in an additional 44% of the feet. No relationship was found between the degree of sensory loss and degree of angulation. Patients with symptomatic hallux valgus may have sensory loss of the toe despite not being aware of the deficit. Normal subjective sensation does not reliably predict normal sensory function. Given the potentially high rates of intra-operative nerve damage in hallux surgery we recommend objective sensory testing as part of routine pre-operative assessment.
