Foot & Ankle International - 2017 FAI Supplement - 40S

Introduction/Purpose: The visual analog scale (VAS) is a
reliable and validated measure of patient reported acute pain.
The clinical implications of the VAS in patients with chronic
pain or postoperative pain is less clear. As patient reported
outcome measures are becoming the standard of care throughout the orthopaedic community, interpretation and clinical
applications are still under investigation. The aim of the current study was to evaluate preoperative patient reported VAS
score reported to nursing staff as compared to the surgeon at
the same clinical visit. Our hypothesis was that there would be
no difference in the scores reported by a single patient to two
different healthcare providers during the same clinic visit.
Methods: The current study was a retrospective cohort of
201 consecutive foot and ankle patients treated by a signal
surgeon. The patients were asked by the nursing staff to rate
their pain intensity using a standard horizontal VAS 0-10,
from "no pain" to the "worst possible pain". At the same
office visit the patients were asked by the treating surgeon
to rate their pain using the same VAS. Dependent t-tests
were calculated to evaluate mean differences in VAS pain
reported by each patient to two different healthcare professional. All data were analyzed using STATA v10.1 with an
alpha level of p<0.05.
Results: The results demonstrate that patients reported
higher pain scores to the surgeon within 81% of the encounters, nursing staff 8% and equal 11%. On average the VAS
score reported to the surgeon (6.17 ±2.12) was significantly
higher higher than that reported to the nursing staff (3.30
±2.26), respectively. The mean difference between the
scores was 2.87 ±2.46 (p=<0.001).
Conclusion: The current study demonstrates a clear and
significant difference in patient reported pain scores
between that given to nursing staff verses the treating surgeon. The cause for the exaggerated pain scores is unclear,
but does lead surgeons to consider patients may have a predetermined desire for surgery. The findings of this study
may also have implications for comparing patient reported
outcome measures prior to surgery to post-surgical outcomes depending on who administers the instrument.
Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00036
©The Author(s) 2017

Modified Evans Osteotomy: A
Cadaveric Study of Structures at Risk
Mohamed Mokhtar Abd-Ella, Assistant
professor, MD
40S

Category: Hindfoot
Keywords: lateral column lengthening, evan osteotomy,
modified evan osteotomy, flat foot deformity
Introduction/Purpose: Lateral column lengthening is
commonly used to treat foot deformities. The original Evans
osteotomy was described to be done 1 to 1.5 cm proximal to
the calcaneocuboid joint. A modified Evans osteotomy
described by Hintermann is done in the sinus tarsi just anterior to the posterior facet. The suggested advantages of the
modified osteotomy are: more stability of the anterior fragment, less probability of injuring the spring ligament, preserving the function of peroneus longus because the
osteotomy is posterior to its sulcus, and a better correction.
However, no studies have assessed the risk of spring ligament injury, posterior facet injury and middle facet injury.
This cadaveric study was done to assess the medial exit
point of the osteotomy in relation to the medial structures.
Methods: The modified Evans osteotomy was performed
by the author who is a foot and ankle consultant in 20 fresh
frozen lower limb specimens. Ten were complete lower
limb specimens and ten were below knee specimens. Ten
were right sided and ten were left sided. After exposure and
peroneal tendon retraction, the osteotomy was done by an
oscillating saw in the sinus tarsi just anterior to the posterior
subtalar facet in a direction perpendicular to the lateral surface of the calcaneus. After completion of the osteotomy,
the talus was dissected and removed and the relation of the
osteotomy to the posterior facet, middle facet, anterior facet
and spring ligament was documented. The distance between
the medial part of the osteotomy and the anterior end of the
posterior subtalar facet was measured, as well as the distance between the medial part of the osteotomy and the posterior border of the middle facet.
Results: The spring ligament was not injured in any
specimen. The posterior facet was not injured in any
specimen with an average distance of 6.45 mm between
the anterior end of the its medial part and the osteotomy
(range: 0-15 mm). The anterior facet was contiguous
with the middle facet in six specimens. The anterior facet
was not injured in any specimen. In six specimens, the
osteotomy passed between the posterior and middle facets just posterior to the middle facet, and in one specimen, it passed between the anterior and middle facets. In
the remaining 13 specimens, the osteotomy passed
through the middle facet with an average distance of 7.07
mm between the osteotomy and the posterior border of
the middle facet (range: 2-13 mm).
Conclusion: This study proves that the modified Evans
osteotomy avoids injury of the spring ligament and the posterior subtalar facet. Although it starts laterally just anterior
Foot & Ankle International 38(1S)

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