Patient Characteristics and Comorbidities in Patients Attending Specialist Foot and Ankle Outpatient Clinics in the UK: A Report of 2000 Patients

Abstract

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: For integrated care and appropraite referral pathways, it is important to understand the patient demographics, pathologies and comorbidities of patients with foot and ankle pain. We are aware of the burden of foot and ankle problems in UK primary care, with a large number of referrals to outpatient orthopaedic clinics (Ferguson et al. Br J Gen Pract, e422, June 2019). With increasing demands on secondary and tertiary care settings, it is important to think of innovative solutions. To our knowledge there is no large patient case series looking at these aspects of care in foot and ankle patients attending outpatient clinics in the UK. Methods: Therefore the aims of this study were to: 1. To gain a better understanding of the demographics and pathologies of patients attending a specialist foot and ankle clinic. 2.To develop our existing knowledge of the types and prevalence of comorbidities within this population. Data was collected prospectively. All new patients attending a specialist foot and ankle clinic in one centre in the UK were asked to complete a proforma at their first assessment (figure 1). Information was collected on gender, age, occupation, hobbies, location of ankle pain, previous injuries, compensation issues, presence of comorbidities and medications. A descriptive analysis of the data was conducted using SPSS (version 19, IBM). Results: Data from 2001 patients was collected. The mean (SD) age was 52.9 (16.9) years with 76% being female. Nine percent of patients had diabetes (though others may have been seen in diabetic/ vascular clinics and not captured here) and 16% were current smokers. Thirty-three percent of patients had a previous history of injury to the foot and/or ankle. The right foot was affected in 49% and the left in 51%. Location of pain was in the forefoot (52%), midfoot (21%) and hindfoot (27%). Compensation issues were reported in 3%. The proportion of patients in work was 64.4% meaning 35.6% were unemployed (including those who had retired). Conclusion: This large study demonstrates that more women attend specialist foot/ ankle clinics in the UK. Both feet are equally affected; the forefoot was the most common site of pathology. The prevalence of diabetes and smoking are in line with the general UK population (reported as 9% and 15%). A small proportion of patients had compensation issues, with the majority of patients working. This data can be used to help streamline referral pathways and to establish innovative ways of working (e.g. virtual clinics). In turn, this may reduce the burden on outpatient clinics, the health economy and improve patient satisfaction.