Marked Mobility Improvement: Men and Women Respond Similarly to Operative Treatment of Foot & Ankle Pathologies

Abstract

Category: Ankle; Hindfoot Introduction/Purpose: Differences between men and women in the perception, incidence, and outcomes of various orthopaedic injuries are well-documented. Recent studies have noted that women display increased ankle ligamentous laxity and double the rate of ankle sprains in relation to their male peers. Current studies indicate that, in general, women and men respond similarly to surgical correction of such pathologies. However, a gender difference in mobility has not been investigated. Given the mobility implications associated with chronic foot and ankle conditions, a need exists to better characterize baseline and postoperative functionality in men and women. The objective of this study was to assess changes in LifeSpace Mobility Assessment (LSA) scores of male and female patients following surgical correction of non-traumatic ankle, hindfoot, and midfoot conditions. Methods: A prospective study of elective ankle, hindfoot, and midfoot procedures conducted by a single surgeon between September 1, 2015 and August 31, 2019 was undertaken following IRB approval. LSA scores on 184 patients - 137 women and 53 men - were collected at preoperative, 3-month, 6-month, and 12-month clinic visits. The electronic medical record was queried for patient demographic and surgical data. Demographics, surgical factors, and patient-reported LSA scores were compared utilizing an independent sample t-test for continuous, normally distributed data. All categorical data was analyzed with a chi- squared or Fischer's exact tests. Alpha and beta were set at 0.05 and 0.8, respectively. Results: The average age of female participants was 51.2 (SD 16.4) years and 48.2 (SD 17.1) years for male participants (p=0.273). There were no significant differences in frequencies of comorbidities (p>0.05). Men and women in this cohort underwent elective foot and ankle surgery for a similar diseases processes, most commonly soft tissue pathology, followed by osteoarthritis (p=0.440). Women had significantly lower LSA scores at preoperative (63.7 [SD 38.1] vs. 84.8 [SD 35.9], p=0.002), 3 month postoperative (52.5 [SD 33.8] vs. 69.9 [SD 34.5], p=0.006), and 1 year postoperative (81.2 [SD 37.2] vs. 105.5 [SD 18.2], p=0.019) timepoints relative to their male peers. No differences in mobility at 6 months postop were observed (p=0.714). Overall, women and men had similar absolute increases in postoperative mobility at 1-year after surgery (17.5 vs. 20.7, p>0.05) as well as similar percentage of increased mobility (27% vs. 24%, p>0.05). Conclusion: The present study provides further evidence of the gender differences in chronic foot and ankle pathologies. Both sexes improved similarly pre to postoperatively, however, women did not reach the same level of absolute mobility as their male counterparts. Prior studies have shown that women characterize a greater degree of limitation with foot and ankle conditions as 'normal' relative to men, making it plausible that they delay treatment until they become more severely symptomatic than men. This persistent deficit highlights the importance of early recognition of mobility impairment in order to preserve function among the sexes in foot and ankle care.