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Outcomes of treatment of foot and ankle fractures: which are important to the patient?

C.A.T. van Leeuwen, T. van der Geest, P. Krijnen, L. van Bodegom-Vos, M.F. Termaat, J.M. Hoogendoorn, I.B. Schipper


Background: Fractures of the ankle and foot are common and may be associated with long-term disabilities. Previous studies have examined functional status as an important patient-reported outcome, but little is known about patient expectations and satisfaction after their treatment. The aim of this study was to assess which outcomes are important to patients with an ankle or calcaneus fracture and to assess which background and fracture characteristics might be associated with these outcomes.

Methods: A cross-sectional survey among 335 patients (response rate: 58%, n = 194) treated for a Weber B/C or calcaneus fracture, was performed. Patients were asked to identify and rank 5 treatment outcomes (out of 22 outcomes) that were the most important to them. The weighted importance of each outcome was calculated and averaged on group level. Stepwise multivariable regression analyses were performed to assess patient characteristics that are associated with patients’ preferences for the most important outcomes.

Results: “Self-sufficiency” was reported most frequently (in 50/194; 25.8%) as the most important outcome, followed by “walking” and “complete recovery”. The top 5 of most important outcomes differed somewhat between patient subgroups. The weighted importance of the outcomes was associated with various patient characteristics.

Conclusions: Self-sufficiency, walking and complete recovery, are generally valued most by patients with an ankle or calcaneal fracture. The surgeon should be aware of this in order to manage any pre-operative discrepancies between surgeons’ and patients’ expectations. Furthermore, evaluation of care should become more focussed on the outcome parameters that matter to the patient, as part of enhanced approaches to providing person-centered healthcare.


Foot and ankle fractures, patient expectations, patient-reported outcomes, person-centered healthcare, self-sufficiency

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