• Thirza A Berk, SmeeingDiederik P JDPJDepartment of General Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands., van der VlietQuirine M JQMJDepartment of General Surgery, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands., LeenenLuke P HLPHDepartment of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands., Falco Hietbrink, Mark C P M van Baal, Roderick M Houwert, and Marilyn Heng.
• Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands. Electronic address: t.a.esselink-3@umcutrecht.nl.
• Injury. 2022 Jun 1; 53 (6): 2366-2372.

IntroductionAdequate foot function is paramount in daily activities, yet the incidence of foot fractures shows a rising trend. Patient-reported outcome measures are increasingly used for research; however, the use of a wide variety of available instruments is undesirable. In the current study, an overview is provided of patient-reported outcome measures used in clinical research evaluating outcomes of foot fractures. Tools are provided to choose the most adequate instrument in future research.MethodsTo identify the instruments, a systematic review was performed using PubMed, Embase, and the Cochrane Library. Articles published since 2000, reporting on traumatic foot fractures and/or their posttraumatic sequelae, and using a minimum of one condition- or region-specific patient-reported outcome measure were included. Forty-nine instruments were identified, used 636 times collectively. These instruments were evaluated on frequency of use, bones or joints analyzed with the instruments, the type and amount of contained items, and existing literature on their psychometric properties.ResultsThe American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale was used predominantly (AOFAS Ankle-Hindfoot Scale; n = 243, 38.2%), followed by the Maryland Foot Score (n = 90, 14.2%). Twenty-seven instruments were included for further analysis. The majority included questions on mobility (27/27) and pain (24/27). Tools to select an adequate instrument for new research are presented in the appendices.DiscussionControversy surrounds the AOFAS Ankle-Hindfoot Scale as other authors have found that its psychometric properties, indicating it measures what it is supposed to measure adequately, are flawed.ConclusionA multitude of specific patient-reported outcome measures concerning foot fractures exists. Furthermore, the predominantly used instrument is deemed insufficient regarding quality as found by other studies. A valid, reliable, and responsive patient-reported outcome measure for clinical research on foot fractures is necessary. The most adequate existing ones for future research on different topics can be found through the tools provided.Copyright © 2022. Published by Elsevier Ltd.

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