Validation of the Foot and Ankle Outcome Score for Use in Infracalcaneal Heel Pain

The minimal important change is not a universal fixed value across diagnoses when using the FAOS and FAAM in patients undergoing elective foot and ankle surgery

PURPOSE

This study aimed to calculate region and diagnosis-specific minimal important changes (MICs) of the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) in patients requiring foot and ankle surgery and to assess their variability across different foot and ankle diagnoses.

METHODS

The study used routinely collected data from patients undergoing elective foot and ankle surgery. Patients had been invited to complete the FAOS and FAAM preoperatively and at 3-6 months after surgery, along with two anchor questions encompassing change in pain and daily function. Patients were categorised according to region of pathology and subsequent diagnoses. MICs were calculated using predictive modelling (MICPRED) and receiver operating characteristic curve (MICROC) method and evaluated according to strict credibility criteria.

RESULTS

Substantial variability of the MICs between forefoot and ankle/hindfoot region was observed, as well as among specific foot and ankle diagnoses, with MICPRED and MICROC values ranging from 7.8 to 25.5 points and 9.4 to 27.8, respectively. Despite differences between MICROC and MICPRED estimates, both calculation methods exhibited largely consistent patterns of variation across subgroups, with forefoot conditions systematically showing smaller MICs than ankle/hindfoot conditions. Most MICs demonstrated high credibility; however, the majority of the MICs for the FAOS symptoms subscale and forefoot conditions exhibited insufficient or low credibility.

CONCLUSION

The MICs of the FAOS and FAAM vary across foot and ankle diagnoses in patients undergoing elective foot and ankle surgery and should not be used as a universal fixed value, but recognised as contextual parameters. This can help clinicians and researchers in more accurate interpretation of the FAOS and FAAM change scores.

LEVEL OF EVIDENCE

Level IV.

Comparison of the effectiveness of peloid therapy and kinesiotaping in patients with unilateral plantar fasciitis: A prospective, randomized controlled study

Objectives

This study aimed to compare the efficacy of peloid therapy and kinesiotaping for unilateral plantar fasciitis (PF).

Patients and methods

In the randomized controlled study, a total of 114 patients (89 females, 25 males; mean age: 45.1±8.3 years; range, 27 to 65 years) diagnosed with unilateral PF between January 2021 and March 2023 were randomly divided into three equal groups: the peloid group (peloid therapy and home-based exercise + heel pad), the kinesiotaping group (kinesiotaping and home-based exercise + heel pad), and the control group (home-based exercise + heel pad). Peloid therapy was performed over two weeks for a total of 10 sessions. Kinesiotaping was applied four times over two weeks. Plantar fascia, calf, and Achilles stretching exercises and foot strengthening exercises were performed, and prefabricated silicone heel insoles were used daily for six weeks. Patients were evaluated three times with clinical assessment scales for pain, the Heel Tenderness Index, and the Foot and Ankle Outcome Score before treatment, at the end of treatment, and in the first month after treatment.

Results

Statistically significant improvements were observed for all parameters at the end of treatment and in the first month after treatment compared to the baseline in every group (p<0.001). No superiority was found between the groups.

Conclusion

Peloid therapy or kinesiotaping, given as adjuncts to home-based exercise therapy and shoe insoles in patients with unilateral PF, did not result in additional benefits.

Incorporating Research into a Busy Clinical Practice: A Practical Approach

Treating patients in clinic can be busy and stressful; however, utilization of well-planned strategic workflows that include the proper information for research studies can result in daily prospective data collection that will be subsequently amenable to retrospective analysis.