The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a patient-reported outcome measure (PROM) that is widely used to evaluate the pain, stiffness, and physical function of patients with osteoarthritis of the hip and knee. Although the WOMAC has also been used for patients after foot and ankle surgery, it has not been validated for this purpose. A total of 130 patients with surgically treated ankle fractures completed the WOMAC, Visual Analogue Scale Foot and Ankle (VAS FA), Lower Extremity Functional Scale (LEFS), 15D Health-Related Quality-of-Life Questionnaire (15D), and Visual Analog Scale for General Health (VAS general health) after foot and ankle surgery. ⋯ The relationships with the VAS-FA, LEFS, 15D, and VAS general health were strong. All relationships were statistically significant (p < .001). The WOMAC provides valid scores for assessing pain, stiffness, and physical function in patients having undergone ankle fracture surgery.
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The area of skin supplied by the cutaneous branch of the obturator nerve (CBO) is highly variable. Although most introductory anatomy texts describe the CBO as innervating only a portion of the medial thigh, there are numerous reports in the literature of CBOs passing the knee to innervate the proximal, middle, or even distal leg. There are no previous reports of CBOs extending to the ankle and foot. ⋯ In both cases, the saphenous branch of the femoral nerve was present but restricted to the area anterior to the great saphenous vein. It is likely that the variant CBOs carried fibers of the L4 spinal nerve and thus provided cutaneous innervation to the medial foot and ankle, a function most commonly reserved for the saphenous branch of the femoral nerve distal to the knee. Saphenous neuropathy is a common postoperative complication of saphenous cutdowns for coronary artery bypass grafts, so the potential involvement of a long CBO can add additional complexity to regional anesthetic blocks for foot and ankle surgery and procedures such as vein harvesting for coronary artery bypass grafts.