Open Access Open Access  Restricted Access Subscription Access

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

Full Text:



Court-Brown, C.M. & Caesar, B. (2006). Epidemiology of adult fractures: a review. Injury 37 (8) 691-697.

Mitchell, M.J., McKinley, J.C. & Robinson, C.M. (2009). The epidemiology of calcaneal fractures. Foot (Edinb) 19, 197.

Ali, M.S., McLaren, C.A., Rouholamin, E. & O’Connor, B.T. (1987). Ankle fractures in the elderly: nonoperative or operative treatment. Journal of Orthopaedic Trauma 1 (4) 275-280.

Friesgaard, K.D., Gromov, K., Knudsen, L.F., Brix, M., Troelsen, A. & Nikolajsen L. (2006). Persistent pain is common 1 year after ankle and wrist fracture surgery: a register-based questionnaire study. British Journal of Anaesthesia 116 (6) 655-661.

McPhail, S.M., Dunstan, J., Canning, J. & Haines, T.P. (2012). Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences. BMC Musculoskeletal Disorders 13, 224.

Anakwe, R., Khan, L.L., Cook, R. & McEachan, J. (2010). Locked volar plating for complex distal radius fractures: Patient reported outcomes and satisfaction. Journal of Orthopaedic Surgery and Research 5, 51.

Leonardsson, O., Rolfson, O., Hommel, A., Garellick, G., Akesson, K. & Rogmark, C. (2013). Patient-reported outcome after displaced femoral neck fracture: a national survey of 4467 patients. Journal of Bone and Joint Surgery American Volume 95, 1693-1699.

Randsborg, P.H., Fuglesang, H.F., Rotterud, J.H., Hammer, O.L. & Sivertsen, E.A. (2014). Long-term Patient-reported Outcome After Fractures of the Clavicle in Patients Aged 10 to 18 Years. Journal of Pediatric Orthopaedics 34, 393-399.

Lateef, F. (2011). Patient expectations and the paradigm shift of care in emergency medicine. Journal of Emergencies, Trauma and Shock 4, 163-167.

Hoang-Kim, A., Miclau, T., Goldhahn, J., Nijman, T.H. & Poolman, R.W. (2014). Patient-important outcome for the assessment of fracture repair. Injury 45 (Supplement 2) S44-S48.

Morshed, S., Corrales, L., Genant, H. & Miclau, T. 3rd. (2008). Outcome assessment in clinical trials of fracture-healing. Journal of Bone and Joint Surgery American Volume 90 (1) 62-67.

Van Harten, C. & Lammers R. (2016). Report ‘The broken ankle.’ Dutch Patient Federation; Utrecht, The Netherlands (in Dutch). Available at:



  • There are currently no refbacks.