American College Of Foot And Ankle Surgeons Research Articles

AI-Assisted Sentiment Analysis of ACFAS Fellowship-Trained Foot and Ankle Surgeon Online Reviews

Online physician ratings and reviews prove useful among patients when selecting a provider. Analyzing such reviews across medical and surgical specialties to determine their emotional tone through sentiment analysis yielded varying levels of positivity, negativity, and neutrality. To provide insight into what patients are saying, this study similarly analyzes the sentiment of physician ratings and reviews among foot and ankle surgeons. Healthgrades ratings and reviews, entered as of February 2024, were collected among the American College of Foot and Ankle Surgeons (ACFAS) fellows along with each surgeon's demographic information. ChatGPT was used to perform a sentiment analysis to describe the positivity, negativity, and neutrality of online physician reviews. Ratings and review sentiment were described among the sample and between sexes. Among 268 fellows, men received higher average rating scores than women (p = 0.02), From the 2,339 reviews, women received a greater proportion of negative reviews compared to men (p<0.001). The overall sentiment scores among men were higher than women (p < 0.001). There existed a very weak inverse relationship between ratings and years in practice (R = -0.16; p = 0.01). Fellowship-trained foot and ankle surgeons received predominantly positive reviews. When comparing sexes, males received higher ratings with higher sentiment scores. As patients place high credence in online reviews when selecting their provider, surgeons should remain mindful of and monitor or manage their online reputation. Level of EvidenceIV

Publication Barriers of Oral Abstracts Presented at the American College of Foot and Ankle Surgeons: 2015-2019

The journal publication rate for oral abstracts presented at the American College of Foot and Ankle Surgeons (ACFAS) is currently the highest reported for any national foot and ankle society, to date (80.7%). Conversion rates for abstracts presented at national society meetings has long served as an indirect proxy for the quality of the content presented. However, it is unclear why some abstracts ultimately fail to achieve publication. The purpose of the present study was to assess the publication barriers of oral abstracts from ACFAS: 2015–2019. Unpublished oral abstracts were procured from a database. A questionnaire was distributed to presenting authors to determine the current status of the abstract, as well as the reasons for the failure to achieve journal publication. Of the 22 oral abstracts that failed to achieve publication, 10 questionnaires were completed. At the time of the survey, none of the abstracts had been submitted for publication. An insufficient amount of time (30%), responsibility tasked to a co-author (30%), low perceived likelihood of acceptance (30%), and low perceived priority (10%), were citied by authors. The present study broadens our understanding regarding the barriers to the conversion of oral abstracts from ACFAS. Projects led by trainees accounted for 2/3′s of the unpublished abstracts; in some cases, the same author accounted for more than 1 unpublished abstract over subsequent years. The onus is on directors to ensure their trainees receive adequate research mentorship and disseminate clinically meaningful findings presented at ACFAS to a broader audience by journal publication.

Factors Associated With the Conversion of Oral Abstracts to Journal Publication After Presentation at the Annual American College of Foot and Ankle Surgeons Conference: 2015 to 2019

The American College of Foot and Ankle Surgeons (ACFAS) oral abstract publication rate (80.7%) is currently the highest reported for any national foot and ankle society conference to date. Factors associated with the conversion of an abstract to a full text journal publication, as well as barriers to the conversion have been previously assessed for the ACFAS 2010 to 2014. The purpose of the present study was to re-assess factors associated with the journal publication, and time to publication of oral abstracts from the ACFAS 2015 to 2019. Databases containing abstract information were procured, and predictor variables were categorized as either abstract, or author specific. Bivariate analysis was conducted using the Mann-Whitney U-Test, Fisher's exact test, chi-square test of independence, or Spearman's rank correlation. Multivariable logistic regression, and generalized linear regression models were utilized to analyze predictor variables. Projects from academic institutions (p = 0.001), by attending faculty (p = 0.012), with formal research training (p = 0.035) were more likely achieve journal publication following conference presentation, in less time. The abstract/author specific variables were the only significant predictors of publication/time to publication, although trends with respect to other variables were identified (region of the college, funding). The present study further broadens our understanding on the factors associated with successful conversion of an oral abstract to journal publication following conference presentation. The associations and trends identified lend credence to previous studies, while also helping to form a foundation for meaningful discussion(s) on how best to aim the colleges research efforts moving forward.

Incidence of Scholarly Publication by Selected Content Experts Presenting at National Society Foot and Ankle Meetings From 2016 to 2020

Continuing medical education (CME) is an important element to maintain licensing requirements, enhance professional competence, and disseminate up to date, evidence-based, treatment recommendations. A key resource of CME are the 2 annual society meetings hosted by the American College of Foot and Ankle Surgeons (ACFAS) and American Orthopedic Foot and Ankle Society (AOFAS). It is assumed that the selected speakers at these meetings are content experts, providing validated expertise on treatment recommendations, rather than anecdotal experience or opinion. Across all medical specialists, peer-reviewed publication(s) on a particular subject matter have long bestowed the ultimate validity of “expertise.” The purpose of this study was to assess the incidence of scholarly publication for invited speakers at the ACFAS and AOFAS annual meetings from 2016 to 2020, in relation to the topic they were selected to present. A review of invited lectures given at the ACFAS and AOFAS annual meetings from 2016 to 2020 was conducted, and lecturer demographics were categorized into predetermined content areas for assessment. Selected speakers were individually cross-referenced with content-specific peer-reviewed published literature, and overall h-index using Scopus. Topic and society specific comparisons were then made. Overall, 1028 lectures were identified during the temporal period. Only 300 (29.18%) presentations were given by a speaker with least one or more publication on the society specific lecture-topic presented. The greatest proportion of lecturers with content-specific publications was Charcot reconstruction (67.57%) followed by ankle fusion/replacement (55%). The average presenter h-index was greatest among total ankle replacement/ankle fusion (12.16 ± 6.90) and Charcot reconstruction (11.27 ± 7.10) content. The results of the present study illustrate a disparity of expertise among different content areas. While both meetings provide well-published lecturers, this study reveals areas for improvement.

Content Expert Lecturers and Their Related Peer Reviewed Publications: An Analysis of Foot &amp; Ankle Societys' Annual Meetings from 2016 to 2020

Category:OtherIntroduction/Purpose:Annual national society meetings for the American College of Foot and Ankle Surgeons (ACFAS) and American Orthopaedic Foot & Ankle Society (AOFAS) have long provided an important resource to disseminate the latest innovations, techniques, and research. However, unlike submitted research abstracts which are screened by a selection committee, there are scant guidelines for selected content experts to present educational content. To date, the ability to publish in a peer-reviewed journal bestows the ultimate validity of academic expertise on a particular subject matter and supports the expertise of the clinician. The purpose of this study was to evaluate for the first time, the incidence of scholarly publication in a peer reviewed journal for invited speakers from the ACFAS and AOFAS annual meetings from 2016 to 2020.Methods:Annual meeting programs for the ACFAS and AOFAS from 2016 to 2020 were compiled by two reviewers. Faculty lists and assigned lecture tract topics from each meeting were entered into password protected databases. Oral and poster abstracts, industry/society sponsored presentations, 'competitions', and 'other events' held during the annual meetings were excluded. Speaker specific variables included: gender, number of peer reviewed journal publications on the assigned subject matter (publications preceding the meetings date), study design, weighted total topic publication citations, and H-index. The weighted total topic publication citations was obtained by dividing the total citation counts for each manuscript on a particular subject by the number of years since its publication. The H-index, an author specific metric of both productivity and citation impact was obtained from searches of an online resource (http://www.scopus.com/freelookup). For the purposes of the present study, only foot and ankle surgeons (DPM, MD, DO) were included for assessment.Results:There were a total 1,028 invited presentations combined between AOFAS (158) and ACFAS (870) at the annual meetings fom 2016-2020. With combined data, 724 (70%) presentations were given by speakers with no publications in the subject matter while 300 (29.2%) were given by speakers with one or more publications. Lecture topics that had the highest percentage of speakers with publications in the subject matter included Wound Care/Limb Salvage (82.8%), Charcot (63.6%) and Total Ankle Replacement/Fusions (50%). Topics with the highest number of speakers without publications on the topic included Trauma (84%), Sports (80.3%) and Forefoot Elective (78.7%). Only the Trauma category of speakers had a statistically significant difference of predicted number of lectures by publication between no publications (3.7 lectures) and those with 1 or more publications (1.6 lecture) with p=0.04.Conclusion:Content expert presentations at national society specialty meetings are a crucial source of continuing education. What makes a speaker a content expert has yet to be defined but is important to consider. Perhaps factors such as peer reviewed publications in subject matter or the speaker's H-index are characteristics to consider in selecting content experts. In our survey of ACFAS and AOFAS annual meetings from 2016-2020, there were many topics were the vast majority of lectures were given by speakers without any publications and dispersed across the spectrum regardless of the speaker's H-Index ranking. Further criteria development is likely needed.

The Financial Implications of Podiatric Foot and Ankle Fellowship: Is Another Year Worth It?

For prospective applicants many variables can factor into the decision to pursue fellowship level training. The purpose of the present study was to give prospective applicants an idea of the financial implications of podiatric foot and ankle fellowship. To calculate the net present value (NPV), weighted mean income data (clinical, general, research, associated research) from podiatric foot and ankle surgeon's (FAS's) with and without fellowship training was obtained. Income from general payments, research, and associated research was collected from manual searches of Open Source Payments. Demographic and clinical income data (based on 2080 hours) for graduate fellows from 4 programs was collected using an anonymous online survey. Socioeconomic data from the 2018 American College of Foot and Ankle Surgeons (ACFAS) compensation survey was used for comparison. The NPV of podiatric FAS's with/without fellowship training was $4.2 million and $3.03 million, respectively. The comparative NPV and cumulative net income difference over 30 years was $1.2 million and $2.5 million, respectively. The mean comparative income difference for fellowship trained podiatric FAS's annually was as follows: clinical (+$69,145.00), general (+$21,797.00), research (+$1,833.00), and associated research (+$414.00). The present study is the first attempt to provide prospective applicants with an idea of the financial implications of podiatric foot and ankle fellowship. Based on the positive NPV, pursuing an ACFAS recognized podiatric foot and ankle fellowship in advanced reconstruction could be considered an "acceptable financial investment", which may positively affect career earnings. Prospective applicants should be cognizant that the NPV varies between fellowship programs. Therefore, the data presented from graduate fellows of the programs included may not be generalizable to graduate fellows from other programs.

Is posterolateral plating better for fixation of Weber B distal fibular fractures than lateral plating: A randomized controlled clinical trial and a review of the literature

Background: The overall outcomes of Weber B lateral malleolar fracture fixation are good. Fixation can be achieved using different methods; however, lag screw fixation combined with a lateral one-third tubular plate is the most popular option. The purpose of this randomized study was to assess clinical, radiographic, and functional outcomes in a cohort of patients who sustained unstable Weber B ankle fracture and were treated surgically with the technique using posterolateral plating and to compare this technique with the conventional lateral plating. Methods: Twenty patients were included in group 1 and managed with conventional lateral plating, and 20 patients (group 2) had posterolateral plating. Patients were evaluated clinically, radiographically, and at the end point according to the ankle module of the American College of Foot and Ankle Surgeons (ACFAS). Both groups were comparable in terms of age, sex, fracture side, and type of injury. Results: No statistically significant difference was noted between the groups in regard to individual scoring parameters and total score (P&gt;0.05). Among all injury types, 80% of group 1 had well to excellent final outcomes compared with 95% of group 2 (P&gt;0.05). Fifteen patients (37.5% of all patients) had complications. Conclusions: Excellent and good results obtainable with posterolateral plating without the problems commonly associated with lateral plating (short screws and intraarticular penetration) and antiglide plating (peroneal tendinitis) lead us to consider this technique as an option among the methods of choice for managing Weber B fractures. Level of Evidence: Level I.

Modified Wilson’s versus scarf osteotomy for treatment of hallux valgus: a prospective clinical randomized controlled study

Background A prospective randomized controlled comparative trial formulated to compare modified Wilson’s osteotomy and scarf osteotomy in treatment of cases of hallux valgus deformity in terms of operative time, functional, radiological outcomes, and complications. Methods Forty cases with hallux valgus were divided randomly into 2 groups; 37 reached the final follow-up (18 underwent scarf and 19 underwent modified Wilson’s osteotomy), average age 37.34 years. Average follow-up period was 24.13 months. Patients were assessed clinically and radiologically, in addition to preoperative and postoperative functional scoring system of American College of Foot and Ankle Surgeons (ACFAS). Results Operative time was 64.91 min in the scarf group compared to 65.63 min in the modified Wilson’s group; x-ray evaluation showed no statistically significant difference between both groups. ACFAS score showed functional improvement in both groups but the improvement was superior in the modified Wilson group 71.17% compared to the scarf group 59.23%. Conclusions Both modified Wilson’s and scarf osteotomies showed nearly same efficacy regarding correction of deformity of the intermetatarsal angle and comparable results clinically but somewhat shorter operative time for the scarf group and personal impression of technical simplicity for the modified Wilson’s osteotomy

Factors Associated With the Journal Publication of Oral Abstracts From the American College of Foot and Ankle Surgeons: 2010 to 2014

The oral abstract publication incidence (76.9%) of the American College of Foot and Ankle Surgeons (ACFAS) is currently the highest reported for any national foot and ankle society conference to date. However, factors associated with the conversion of an abstract to a journal publication (JP) remain undetermined. The purpose of the present study was to identify the factors associated with the JP and time to publication for oral abstracts from the ACFAS conference from 2010 to 2014. Databases containing information on the abstracts were procured, and predictor variables were categorized as abstract or author specific. Bivariate analysis was conducted using the Mann-Whitney U test, Fisher's exact test, chi-square test of independence, or Spearman's rank correlation. Multivariable logistic regression and generalized linear regression models were utilized to analyze predictor variables. Oral abstracts by authors without a formal research degree were >12 times (95% confidence interval 2.25 to 71.67) more likely to achieve JP compared to abstracts by authors with a research degree. The author-specific variable was the only significant predictor of future JP (p = .002); however, trends with respect to other variables (funding, prior publications, and ACFAS regional division) were also identified. Abstracts originating from academic institutions (p = .042) and those involving fewer centers (p = .03) were associated with a significantly shorter time to publication. Although the present study broadens our understanding on the publication incidence and time to publication for oral abstracts from the ACFAS from 2010 to 2014, it remains unclear why almost a quarter of the abstracts accepted ultimately failed to achieve JP. Identifying the publication barriers of those abstracts remains a necessary first step in helping to form recommendations aimed at improving the future publication incidence for oral abstracts presented at the ACFAS conference.

Publication Rates for Oral Manuscript and Poster Presentations From the American College of Foot and Ankle Surgeons: 2010 to 2014

The American College of Foot and Ankle Surgeons (ACFAS) annual conference has served as a premiere platform to disseminate the latest innovations and research in the field of foot and ankle surgery. The quality of national society conferences is often assessed indirectly by analyzing the the journal publication rate of the abstracts presented. The purpose of this retrospective study was to assess the journal publication rate for abstracts (oral manuscripts and posters) accepted for presentation at the ACFAS conference from 2010 to 2014. All accepted abstracts from this period were compiled by the ACFAS office. PubMed, Google Scholar, and Scopus searches were performed using abstract titles and author names. Overall, the journal publication rate was 76.9% (83 of 108) for oral manuscripts and 23.2% (258 of 1113) for poster abstracts. The mean time to publication was 9.6 (range 0 to 44) months and 19.8 (range 0 to 66) months for oral and poster abstracts, respectively. The most common journal for abstract publication was The Journal of Foot and Ankle Surgery. Notably, the ACFAS oral manuscript publication rate from 2010 to 2014 (76.9%) exceeded its previously reported rate from 1999 to 2008 (67.5%) and the American Orthopaedic Foot and Ankle Society podium publication rate from 2008 to 2012 (73.7%). To the best of our knowledge, the publication incidence for oral abstracts presented at the ACFAS conference is now the highest reported of any national foot and ankle society conference to date.

Anatomic Reconstruction Versus Traditional Rebalancing in Lesser Metatarsophalangeal Joint Reconstruction

Traditional rebalancing techniques, such as capsulotomies and capsulorrhaphies, are commonly performed during complex hammertoe and lesser metatarsal osteotomy procedures involving metatarsophalangeal joint (MTPJ) contractures; however, floating toes, digital instability, and malalignment are concerns. We critically analyzed the outcomes after anatomic reconstruction of the plantar plate and collateral ligaments compared with those after traditional rebalancing techniques. A case-control study was conducted of 54 patients who had undergone surgical correction of lesser MTPJ imbalances due to complex hammertoe deformities (power 80%, type I error = 0.05). Cases were defined as consecutive patients treated with anatomic plantar plate and collateral ligament reconstruction. Controls had undergone traditional lesser MTPJ rebalancing and were matched to cases by age, gender, follow-up duration (minimum 12 months), and concomitant procedures of the same lesser ray. Multivariate logistic regression demonstrated that patients treated with anatomic reconstruction had greater digital stability (negative dorsal drawer and negative paper pull-out test findings) at final follow-up examination compared with the controls. American College of Foot and Ankle Surgeons (ACFAS) forefoot module scores were greater in the anatomic group in all domains (p ≤ .05). Controls had greater postoperative radiographic MTPJ angles than the cases, with no differences detected between the 2 groups in visual analog scale scores or proximal interphalangeal joint angles. The importance of restoration of the plantar plate and collateral ligament integrity as a digital stabilizer is generally accepted but has not been well studied. We found that anatomic reconstruction yielded greater digital stability, greater ACFAS Forefoot module scores, and better radiographic MTPJ alignment than controls. Additional studies are warranted to assess the long-term viability of anatomic lesser MTPJ reconstruction.

Scarf versus long chevron osteotomies for the treatment of hallux valgus: A prospective randomized controlled study

BackgroundThe aim of this study is to compare scarf osteotomy and long chevron osteotomy in treatment of hallux valgus deformity regarding operative time, power of correction and complications. DesignA prospective randomized controlled comparative trial. Methods48 cases with hallux valgus were divided randomly in 2 groups (21 treated by scarf and 22 treated by long chevron osteotomy and 5 were missed during follow up), average age 36 years, follow up time was average of 25.9 months. Patients were assessed clinically, radiologically, and functional scoring system of American College of Foot and ankle Surgeons (ACFAS)was used both pre and postoperatively. ResultsOperative time was 69min in scarf group compared to 63min to long chevron group, radiological correction showed no statistically significant difference between both groups while functional improvement in ACFAS score was in favour of long chevron group 69.1% compared to scarf group 57.5% ConclusionsBoth osteotomies possess almost identical corrective power of the IMA (intermetatarsal angle) and similar clinical outcomes with slightly shorter operative time and subjective technical simplicity for the long chevron osteotomy.

First Metatarsophalangeal Arthrodesis Fixation with an Intramedullary System

Category: Midfoot/Forefoot Introduction/Purpose: Artrhrodesis is a commonly and successfully used procedure to deal with advanced hallux rigidus, severe hallux valgus, inflammatory and posttraumatic arthritis and as a salvage of previous failed surgeries. Many different techniques, in terms of joint preparation and fixation constructs, have been reported. The purpose of this study is to evaluate our short time results with an intramedullary device to perform the first metatarsophalangeal (MTP) arthrodesis. Methods: A descriptive observational study with prospective follow-up was developed. We included 21 arthrodesis using an Intramedullary Fusion Device, which consists in a 6.5 mm intramedullary metatarsal implant and a hooked 4.0 mm lag screw. The indications were hallux rigidus grade 4 in 10 cases, severe hallux valgus in 7, two patients with hallux varus and two cases of salvage surgery of a previous Keller Brandes. Clinical outcomes were assessed with American College of Foot and Ankle Surgeons (ACFAS) scoring scale preoperatively and at the time of the radiological fusion. The degree of satisfaction of patients was also evaluated using the Coughlin and Mann scale. Results: Fusion was achieved at five to twelve weeks in 19 patients. The grade of satisfaction was excellent and good in 18 patients. In two cases, implant breakage occurred. ACFAS score improved 40 points respect to preoperative status. No complications related to infection were reported. Conclusion: Dorsal plate fixation augmented with plantar lag screw fixation is nowadays the reference technique to perform first MTP arthrodesis, nevertheless titanium staples and crossed screws have also reported good results. In these constructs, sometimes is necessary a second surgery to remove some disturbing material. An intramedullary device would avoid the soft tissue irritation due to the underlying material and seems reliable to provide a strong fixation to achieve early MTP fusion with good short-term evolution.

American College of Foot and Ankle Surgeons’ Clinical Consensus Statement: Perioperative Prophylactic Antibiotic Use in Clean Elective Foot Surgery

Some controversy exists regarding the use of antibiotic prophylaxis in elective foot and ankle surgery. A task force was appointed by the American College of Foot and Ankle Surgeons (ACFAS) to provide a clinical consensus statement on this topic. The panel members performed a literature search and identified 6 studies that met the inclusion criteria. They then developed a list of 13 questions about which they attempted to reach consensus using a modified Delphi method. The questions were grouped into 4 categories: indications for antibiotic prophylaxis relative to surgical procedure; antibiotic prophylaxis in high-risk patients; antibiotic selection; and timing of antibiotic prophylaxis. Consensus was reached for all 13 questions. The panel members found that studies pertaining specifically to elective foot and ankle surgeries that were not level I evidence generally did not recommend prophylaxis. They also found that multispecialty guidelines, which reflect data that are stronger, tended to recommend routine prophylaxis, especially for surgeries involving hardware. In addition, many hospital systems support routine prophylaxis by surgeons. More high-level evidence is required to make a definitive determination about whether prophylaxis is necessary in elective foot and ankle surgery. Until that time, routine prophylaxis will likely be continued at most institutions, because few complications have been reported with the practice.

Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents.

BackgroundAccessory navicular can become symptomatic in childhood, and in some cases, the condition is associated with progressive flattening of the longitudinal arch. Moreover, some severe, rigid flatfoot deformities are associated with an accessory navicular. We investigated the results of concomitant calcaneo-cuboid-cuneiform osteotomies (triple C) and the modified Kidner procedure for severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.MethodsTwenty-one feet of 13 patients (nine boys, four girls; mean age 12.7 years) with severe flatfoot associated with a symptomatic accessory navicular who were treated with concomitant triple C and the modified Kidner procedure were evaluated based on clinical and radiographic examinations preoperatively and at a mean follow-up of 22.4 months (range, 12–36 months). We measured 12 variables on the anteroposterior (AP) and lateral weight-bearing radiographs, and we used the American College of Foot and Ankle Surgeons (ACFAS) score for clinical assessment.ResultsWe found significant improvements (p < 0.001) in eight of the 12 radiographic measurements: the AP talo-first metatarsal (MTT) angle, AP talo-navicular coverage angle, AP talo-calcaneal angle, lateral talo-first MTT angle, calcaneal pitch, lateral talo-calcaneal angle, lateral talo-horizontal angle, and naviculo-cuboid overlap. Average ACFAS scores were significantly improved at the time of the last follow-up (p < 0.001). The only complication was overcorrection of the hindfoot in one patient.ConclusionsConcomitant triple C and the modified Kidner procedure result in favorable radiographic and clinical outcomes in the treatment of severe flatfoot associated with a symptomatic accessory navicular in children and adolescents.

Evaluation of the Rearfoot Component (Module 3) of the ACFAS Scoring Scale

The American College of Foot and Ankle Surgeons (ACFAS) scoring scale modules 3 and 4 have not been validated or tested against other validated instruments widely used in medical and surgical research and practice. The purpose of the present study was to evaluate the rearfoot component (module 3) of the ACFAS scoring system by assessing its correlation against well-established instruments. A modified ACFAS scale (mACFAS), Medical Outcomes Study 36-item short form (SF-36), version 2 (SF-36v2), and the short form of the International Physical Activity Questionnaire (IPAQ) were administered to subjects enrolled in our ongoing longitudinal cohort flatfoot study. Eighty-six patients were evaluated. The mACFAS correlated moderately to highly with the SF-36v2 physical component score and moderately with the mental component score and IPAQ. When divided into higher arched, lower arched, and rectus foot groups, the mACFAS correlated more strongly with the SF-36v2 and correlated with the IPAQ in the lower arched population. The results of the present study are promising for the rearfoot component of the ACFAS scoring scale, especially in the evaluation of the lower arched foot type. Future research should evaluate the disease- and symptom-specific validity, responsiveness, and reproducibility of the mACFAS.

Comparison of the Calcaneo-Cuboid-Cuneiform Osteotomies and the Calcaneal Lengthening Osteotomy in the Surgical Treatment of Symptomatic Flexible Flatfoot

Surgery is indicated in symptomatic flatfoot when conservative treatment fails to relieve the symptoms. Osteotomies appear to be the best choice for these painful feet. The purpose of this study was to compare the clinical and radiographic outcome of the calcaneo-cuboid-cuneiform osteotomies (triple C) and the calcaneal-lengthening osteotomy in the treatment of children with symptomatic flexible flatfoot. The surgeries were performed by senior surgeons who preferred either triple C or calcaneal lengthening. The results were graded by an orthopaedic surgeon uninvolved with the cases. The clinical and radiographic outcome was evaluated in 30 feet (21 patients) with a triple C osteotomy and 33 feet (21 patients) with a calcaneal-lengthening osteotomy. We used the American College of Foot and Ankle Surgeons (ACFAS) score (flatfoot module) for clinical assessment, which contains a subjective and objective test. We measured and compared 12 parameters on the anteroposterior and lateral weight-bearing radiographs. The effect of additional procedures (Kidner procedure, medial reefing of the talonavicular capsule, tendo-Achilles lengthening, peroneous brevis lengthening and, in the calcaneal-lengthening group, a medial cuneiform osteotomy) on the clinical and radiographic result was also evaluated. Average age at the time of surgery was similar (triple C: 11.2 ± 3 y, calcaneal lengthening: 11.6 ± 2.5 y, P = 0.51). Average follow-up was 2.7 ± 2.2 years in the triple C group and 5.3 ± 4 years in the calcaneal-lengthening group. There were no significant differences in the clinical outcome measured by the ACFAS subjective test in the calcaneal-lengthening group (P = 0.003). There were no significant differences in the ACFAS score, both the subjective test (triple C: 43.3 ± 6.1, calcaneal lengthening: 44.7 ± 7.6, P = 0.52) and the ACFAS objective test (triple C: 28.6 ± 2, calcaneal lengthening: 25.9 ± 7, P = 0.13). We found significant differences in 2 of the 12 radiographic measurements: anteroposterior talo-first metatarsal angle (triple C: 15.5 ± 11.1, calcaneal lengthening: 7.4 ± 7.3, P = 0.001) and talonavicular coverage (triple C: 28 ± 14.7, calcaneal lengthening: 13.7 ± 12.4, P<0.001). None of the additional procedures improved the clinical outcome. There were 3 (10%) complications in the triple C group and 6 (18%) complications in the calcaneal-lengthening group. Also, calcaneocuboid subluxation was present in 17 (51.5%) feet of the calcaneal-lengthening group. Both techniques obtain good clinical and radiographic results in the treatment of symptomatic idiopathic flexible flatfoot in a pediatric population. The calcaneal-lengthening osteotomy achieves better improvement of the relationship of the navicular to the head of the talus but it is associated with more frequent and more severe complications. Additional soft-tissue procedures have not proven to improve clinical or radiographic results. Level III, retrospective comparative study.

Publication Rates of Poster Presentations at the American College of Foot and Ankle Surgeons Annual Scientific Conference Between 1999 and 2008

Publication is the desired end point of scientific research. Ultimately, it is desired that research presented in poster format at a scientific conference will be developed into a report and become published in a peer-reviewed scientific journal. Moreover, poster presentations of research studies are often referenced and, as a result, influence treatment care plans. No data exist for the actual publication rate of podiatric foot and ankle surgery poster presentations. Therefore, the objective of the present study was to determine the actual publication rates of poster presentations at the American College of Foot and Ankle Surgeons (ACFAS) annual scientific conference (ASC) during a 10-year period. Print or electronic media for the ACFAS ASC official program from 1999 to 2008 were obtained. Each year's official program was manually searched for any poster presentation and, when identified, the authors and title were individually searched using Internet-based search engines to determine whether a poster presentation had been followed by publication. Of the 825 posters, 198 (24%) poster presentations were ultimately published in 1 of 32 medical journals within a weighted mean of 17.6 months. Of the 32 journals, 25 (78.1%) represented peer-reviewed journals. The publication rate of poster presentations at the ACFAS ASC was less than that of oral manuscripts presented at the same meeting during the same period and was also less than the orthopedic subspecialty poster presentation publication rates. Therefore, attendees of the ACFAS ASC should be aware that only a few of the posters presented at the ACFAS ASC will be valid because they will not survive the rigors of publication 76% of the time. Additionally, more stringent selection criteria should be used so that the selected poster presentations can ultimately withstand the publication process.

Validation of the American College of Foot and Ankle Surgeons Scoring Scales

The American College of Foot and Ankle Surgeons (ACFAS) assembled a task force to develop a scoring scale that could be used by the membership and practitioners-at-large. The original publication that introduced the scale focused primarily on use of the scale and provided only brief background on the development of the health measurement instrument. Concerns regarding the validity and reliability of the scale were raised within the professional community, and ACFAS assembled a task force to address these concerns. The purpose of this article is to address the issues raised by reporting the detailed methods used in the development of the ACFAS Scoring Scales. The authors who constitute this task force reviewed the body of work previously conducted and applied standards that serve to evaluate the scoring scale for: 1) validity, 2) reliability, and 3) sensitivity to change. The results showed that a systematic and comprehensive approach was used in the development of the scoring scales, and the task force concluded that the statistical methods and instrument development process for all 4 modules of the scoring scales were conducted in an appropriate manner. Furthermore, modules 1 and 2 have been rigorously assessed and the elements of these modules have been shown to meet standards for validity, reliability, and sensitivity to change.

Publication Rates of Manuscript Presentations at the American College of Foot and Ankle Surgeons Annual Scientific Conference Between 1999 and 2008

Publication is the ultimate desired end point of scientific research. However, oral manuscript presentations of research studies are often referenced in textbooks, journal articles, and industry white papers, and, as a result, influence treatment care plans. No data exist for the actual publication rate of podiatric foot and ankle surgery oral manuscript presentations. Therefore, the objective of this study was to determine the actual publication rates of oral manuscript presentations at the American College of Foot and Ankle Surgeons (ACFAS) Annual Scientific Conference over 10 years. Print or electronic media for the ACFAS Annual Scientific Conference official program between 1999 and 2008 were obtained. Each year's official program was hand searched for any oral manuscript presentation, and, when identified, the title and authors were individually searched through electronic internet-based search engines to determine whether an oral manuscript presentation had been followed by publication of a full-text article. Additionally, pertinent journals were hand searched for potential articles. A total of 67.5% (139/206) oral manuscript presentations were ultimately published in 1 of 12 medical journals in a mean of 14.5 months. All journals except one (91.7%) represented peer-reviewed journals. The publication rate of oral manuscript presentations at the ACFAS Annual Scientific Conference is similar to or greater than orthopaedic subspecialties, including foot and ankle surgery, publication rates. Based on the above, attendees of the ACFAS Annual Scientific Conference should be aware that the majority of oral manuscript material presented at the ACFAS Annual Scientific Conference can be considered as accurate because they survive the rigors of the peer-review process more than two thirds of the time.