Non-Operative Management for Osteochondral Lesions of the Tibial Plafond Results in Minor Improvements of Patient-Reported Outcomes: A 2-Year Prospective Follow-Up Study.

Outcome assessment is critical in evaluating the efficacy of orthopaedic procedures. The Foot and Ankle Outcome Score (FAOS) is a 42-item questionnaire divided into five subscales, which has been validated in several languages. Germany has no validated outcome score for general foot and ankle pathology. The aim of this study was to develop a German version of the FAOS and to investigate its psychometric properties. Forward and backward translation was executed according to official guidelines. The final version of the FAOS was investigated in 150 patients with various foot and ankle disorders. All patients completed the FAOS, Short Form-36, numeric rating scales for pain and disability, and the Hannover questionnaire. The FAOS was re-administered after 1 week. Test-retest reliability, internal consistency, minimal detectable change, construct validity, and floor and ceiling effects were analyzed. Test-retest reliability and internal consistency of each subscale were excellent (intraclass correlation coefficient, 0.88-0.95; Cronbach's α, 0.94-0.98). The minimal detectable changes of each subscale were 17.1-20.8 at the individual level and 2.0-2.4 at group level. There were moderate to strong correlations between FAOS subscales and physical outcomes and low to moderate correlations between FAOS subscales and mental outcomes. Floor and ceiling effects were not present. The German version of the FAOS is a reliable and valid instrument for use in foot and ankle patients.

PurposeTo develop a translated Dutch version of the Cumberland Ankle Instability Tool (CAIT) and test its psychometric properties in a Dutch population with foot and ankle complaints.MethodsThe CAIT was translated into the Dutch language using a forward–backward translation design. Of the 130 subsequent patients visiting the outpatient clinic for foot and ankle complaints who were asked to fill out a questionnaire containing the CAIT, the Foot and Ankle Outcome Score (FAOS), and the numeric rating scale (NRS) pain, 98 completed the questionnaire. After a 1-week period, patients were asked to fill out a second questionnaire online containing the CAIT and NRS pain. This second questionnaire was completed by 70 patients. With these data, the construct validity, test–retest reliability, internal consistency, measurement error, and ceiling and floor effects were assessed. Additionally, a cut-off value to discriminate between stable and unstable ankles, in patients with ankle complaints, was calculated.ResultsConstruct validity showed moderate correlations between the CAIT and FAOS subscales (Spearman’s correlation coefficient (SCC) = 0.36–0.43), and the NRS pain (SCC = −0.55). The cut-off value was found at 11.5 points of the total CAIT score (range 0–30). Test–retest reliability showed to be excellent with an intraclass correlation coefficient of 0.94. Internal consistency was high (Cronbach’s α = 0.86). No ceiling or floor effects were detected.ConclusionBased on the results, the Dutch version of the CAIT is a valid and reliable questionnaire to assess ankle instability in the Dutch population and is able to differentiate between a functionally unstable and stable ankle. The tool is the first suitable tool to objectify the severity of ankle instability specific complaints and assess change in the Dutch population.Level of evidence II.

ObjectiveThe purpose of this retrospective case series was to evaluate clinical outcomes following both conservative treatment and arthroscopic bone marrow stimulation (BMS) for the management of symptomatic subtalar osteochondral lesions (OCLs).DesignAll symptomatic subtalar OCLs with a minimum of 12 months follow-up having undergone either a conservative management or arthroscopic procedure were included. Patient-reported outcomes were collected via questionnaires consisting of the Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS) of pain in rest, during walking, during stair climbing, and during running. In addition, return to sports data, return to work data, reoperations, and complications were collected and assessed. In total, 11 patients across 2 academic institutions were included (3 males, 8 females). The median age was 43 years (interquartile range [IQR]: 32-53).ResultsAll patients underwent conservative treatment first; in addition, 9 patients underwent subtalar arthroscopic debridement with or without BMS. The median follow-up time was 15 months (IQR: 14-100). In the surgically treated group, the median NRS scores were 2 (IQR: 1-3) during rest, 3 (IQR: 2-4) during walking, 4 (IQR: 4-5) during stair climbing, 5 (IQR: 4-5) during running and the median FAOS score at final follow-up was 74 (IQR: 65-83). In the conservatively treated patients, the median NRS scores were all 0 (IQR: 0-0) and the median FAOS scores were 90 (IQR: 85-94). In the group of surgical treated patients, 4 were able to return to the same level of sports, 2 returned to a lower level of sports. Both conservatively treated patients returned to the sport and the same level of prior participation. All patients except one in the surgical group returned to work.ConclusionsThis retrospective case series demonstrated that a high number of patients converted to surgery after initial conservative treatment. In addition, debridement and BMS show good clinical outcomes for the management of symptomatic subtalar OCLs at short-term follow-up. No complications nor secondary surgical procedures were noted in the surgically treated group. The high rate of failure of conservative treatment suggests that surgical intervention for symptomatic subtalar OCLs can be the primary treatment strategy; however, further research is warranted in light of the small number of patients.

The aims of this study were to culturally adapt and validate the Persian version of Foot and Ankle Outcome Score (FAOS) and present data on its psychometric properties for patients with different foot and ankle problems. The Persian version of FAOS was developed after a standard forward-backward translation and cultural adaptation process. The sample included 93 patients with foot and ankle disorders who were asked to complete two questionnaires: FAOS and Short-Form 36 Health Survey (SF-36). To determine test-retest reliability, 60 randomly chosen patients completed the FAOS again 2 to 6 days after the first administration. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate convergent and divergent validity of FAOS compared to similar and dissimilar concepts of SF-36, the Spearman's rank correlation was used. Dimensionality was determined by assessing item-subscale correlation corrected for overlap. The results of test-retest reliability show that all the FAOS subscales have a very high ICC, ranging from 0.92 to 0.96. The minimum Cronbach's alpha level of 0.70 was exceeded by most subscales. The Spearman's correlation coefficient for convergent construct validity fell within 0.32 to 0.58 for the main hypotheses presented a priori between FAOS and SF-36 subscales. For dimensionality, the minimum Spearman's correlation coefficient of 0.40 was exceeded by most items. In conclusion, the results of our study show that the Persian version of FAOS seems to be suitable for Iranian patients with various foot and ankle problems especially lateral ankle sprain. Future studies are needed to establish stronger psychometric properties for patients with different foot and ankle problems.

Category: Ankle; Ankle Arthritis Introduction/Purpose: Osteochondral lesions of the talus (OLT) are lesions that affect both the articular cartilage and underlying subchondral bone that often arise after trauma. Large OLTs may be treated using osteochondral autografts, for example from the ipsilateral knee. This, however, often results in donor site morbidity. Moreover, the cylindric nature of the osteochondral grafts does not allow for a perfect fit for the defect. The novel technique Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) overcomes these challenges by using an osteoperiosteal autograft of the ipsilateral iliac crest. The aim of the present study is to prospectively evaluate the clinical, radiological and safety outcomes after 5 years of follow-up for patients who underwent the new TOPIC procedure for an OLT. Methods: A prospective cohort study of patients who underwent the TOPIC procedure was conducted. The primary outcome was the Numeric Rating Scale (NRS) of pain during walking. Other clinical outcomes included the NRS during rest and stair climbing, the Foot and Ankle Outcome Score (FAOS) and the Mental Component Score (MCS) and Physical Component Score (PCS) of the Short Form-36 (SF-36). In addition, the AOFAS ankle-hindfoot score was measured. All clinical outcomes were measured preoperatively and after 6 months, 1 year, 2 years and 5 years of follow-up. Computed tomography (CT) scans were performed preoperatively and postoperatively at 12 weeks, 1 year, 2 years and 5 years to assess osteotomy union, graft consolidation and graft cyst development. In addition, complications and hardware removal were evaluated. Results: 36 patients (current data is 29pt; expected to be complete at congress) were assessed, and no patient were lost to follow-up. The NRS of pain during walking improved from 6.5 [5-8] preoperatively to 2 [1-3] at 5-year follow-up (p < 0.001). The NRS during rest and stair climbing improved with 2 (p = 0.002) and 4 points (p < 0.001), respectively. All FAOS subscales improved significantly. The SF-36 PCS improved (32 to 35; p = 0.059) and the MCS improved (39 to 47; p < 0.001). The AOFAS improved from 52 to 90 (p < 0.001). There was 100% union at the osteotomy site after 12 weeks and 100% of the graft showed consolidation at 1, 2 and 5 years postoperatively. No major complications occurred. Conclusion: The TOPIC procedure is an effective treatment option for large osteochondral lesions of the talus, with durable results after 5 years of follow-up. A significant improvement in clinical outcomes was observed, with excellent radiological results. No major complications were recorded.

The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1year after an Achilles tendon rupture. This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities. A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p = 0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p = 0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p = 0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC = 0.87-0.93). BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test. I.

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.

IntroductionLiterature on treatment outcomes in skeletally immature patients with osteochondral lesions of the talus (OLT) is scarce. As the healing of an OLT may be fundamentally different in a skeletally immature patient, more evidence is required focusing on this specific patient group. The primary aim of this study is to assess the conversion to surgery rate after initial non-operative management in skeletally immature patients with an OLT. The secondary aims of the present study are to assess and compare the clinical outcomes and reoperations after both non-operative and surgical treatment strategies at a mid- to long-term follow-up.MethodsAll skeletally immature patients at the moment of initial treatment, treated for their primary or non-primary OLT with a minimum follow-up duration of 2 years, were included in this study. Patients with concomitant injuries were excluded. All patients started with non-operative management. In case of failure of non-operative management, patients converted to Bone Marrow Stimulation (BMS) or fixation. The primary outcome was the conversion to surgery rate after initial non-operative management. Secondary outcomes consist of reoperations at mature and immature age, pain during weight bearing, measured by the numeric rating scale (NRS), NRS of pain during rest, NRS during stair climbing, Berndt and Harty outcome question, Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) and the patient satisfaction rate regarding the received treatment.ResultsA total of 52 patients, 54% female, mean age of 13.6 years, were included in this study. Median follow-up duration was 81 months (range = 24-265 months). Seventeen patients received non-operative treatment as final treatment. In total, 35 (67%) out of 52 patients required surgical treatment after initial non-operative management, of which 14 underwent BMS and 20 had fixation while skeletally immature, 1 patient that had surgical treatment as an adult was excluded for further analysis. The median NRS of pain during weight bearing was 1 (interquartile range [IQR] = 0-2), 1 (IQR = 0-3), and 0 (IQR = 0-0.5) in the (sustained) non-operative, BMS, and fixation groups, respectively (P < 0.012). No significant differences in clinical outcomes between the different treatment groups could be observed. No complications occurred after surgical treatment. Reoperation rates were 21% and 20% in the BMS and fixation groups, respectively.ConclusionsThe most important finding of this study is that 67% of the patients receiving initial non-operative management for OLTs ultimately required surgery.Level of evidenceLevel III, cross-sectional comparative study.

Background:The results of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for lateral osteochondral lesions of the talus (OLTs) are unknown. Therefore, the present prospective study aims to assess the numeric rating scale (NRS) of pain during walking at 2-year follow-up. Secondarily, the aim is to assess other clinical, radiologic, and safety outcomes.Methods:This is a single-center, nonrandomized prospective cohort study in which all press-fit lateral TOPIC patients for an OLT are included. Patients with a follow-up of at least 2 years without a concomitant osteochondral lesion of the tibial plafond were included. The primary outcome is the NRS of pain during walking. Secondary clinical outcomes included the NRS during rest and during stair climbing. Additionally, the Foot and Ankle Outcome Score (FAOS), the AOFAS ankle-hindfoot score, and the mental and physical component summary of the 36-Item Short Form Health Survey were recorded. Radiologic follow-up was performed using computed tomography (CT) scans.Results:After application of the inclusion and exclusion criteria, 7 patients were included in the present study. The median age at time of surgery was 31.1 years. The NRS of pain during walking improved from a median of 5 (4-7) preoperatively to 1 (0-1) at 2 years of follow-up (P = .02). All FAOS subscales improved significantly, except the FAOS symptoms subscale. Graft consolidation was observed in 100% of the patients and cysts were present in 5 of 6 patients. No complications occurred and no patients complained of donor site morbidity. No reoperations were performed.Conclusion:In the first 7 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from median 5 preoperatively to 1 at 2-year follow-up was observed.

PurposeTo describe the long-term clinical results of arthroscopic fragment fixation for chronic primary osteochondral lesions of the talus (OLT), using the Lift-Drill-Fill-Fix (LDFF) technique.MethodsEighteen patients (20 ankles) underwent fixation for a primary OLT with an osteochondral fragment using arthroscopic LDFF and were evaluated at a minimum of 5-year follow-up. Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking and when running. Additionally, the change in Foot and Ankle Outcome Score (FAOS) and the procedure survival (i.e., no reoperation for the OLT) at final follow-up was assessed.ResultsAt a mean follow-up of 7 years, the median NRS during walking significantly improved from 7 (IQR 5–8) pre-operatively to 0 (IQR 0–1.5) at final follow-up (p = < 0.001). This result was sustained from 1-year follow-up to final follow-up. The NRS during running significantly improved from 8 (IQR 6−10) to 2 (IQR 0–4.5) (p < 0.001) and the NRS in rest from 2.5 (IQR 1–3) to 0 (IQR 0–0) (p = < 0.001). The median FAOS at final follow-up was 94 out of 100 for pain, 71 for other symptoms, 99 for activities of daily living, 80 for sport and 56 for quality of life. The FOAS remained significantly improved post-operatively on all subscales, except for the symptoms subscale. The procedure survival rate is 87% at final follow-up.ConclusionArthroscopic LDFF for fixable chronic primary OLTs results in excellent pain reduction and improved patient-reported outcomes, with sustained results at long-term follow-up. These results indicate that surgeons may consider arthroscopic LDFF as treatment of choice for fragmentous OLT.Level of evidenceLevel IV, prospective case series.

PurposeThe purpose of this study was to describe the mid-term clinical and radiological results of a novel arthroscopic fixation technique for primary osteochondral defects (OCD) of the talus, named the lift, drill, fill and fix (LDFF) technique.MethodsTwenty-seven ankles (25 patients) underwent an arthroscopic LDFF procedure for primary fixable talar OCDs. The mean follow-up was 27 months (SD 5). Pre- and post-operative clinical assessments were prospectively performed by measuring the Numeric Rating Scale (NRS) of pain in/at rest, walking and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) and the Short Form-36 (SF-36) were used to assess clinical outcome. The patients were radiologically assessed by means of computed tomography (CT) scans pre-operatively and 1 year post-operatively.ResultsThe mean NRS during running significantly improved from 7.8 pre-operatively to 2.9 post-operatively (p = 0.006), the NRS during walking from 5.7 to 2.0 (p < 0.001) and the NRS in rest from 2.3 to 1.2 (p = 0.015). The median FAOS at final follow-up was 86 for pain, 63 for other symptoms, 95 for activities of daily living, 70 for sport and 53 for quality of life. A pre- and post-operative score comparison was available for 16 patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 to 50.1. Of the CT scans at 1 year after surgery, 81% showed a flush subchondral bone plate and 92% of OCDs showed union.ConclusionArthroscopic LDFF of a fixable primary talar OCD results in excellent improvement of clinical outcomes. The radiological follow-up confirms that fusion of the fragment is feasible in 92%. This technique could be regarded as the new gold standard for the orthopedic surgeon comfortable with arthroscopic procedures.Level of evidenceProspective case series, therapeutic level IV.

What's New in Foot and Ankle Surgery.

Do Patient Personality Traits and Self-Reported Physical and Psychosocial Symptoms Help to Predict Hallux Valgus Surgery Outcomes?

Introduction/Purpose:Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation.Methods:A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases.Results:Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8.Conclusion:Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning but they have not been reported in the setting of midfoot Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship-trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS-8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.