Is there a learning curve in foot and ankle surgery?

Previous studies of orthopaedic learning curves have largely described the introduction of new techniques to experienced consultants. End points have usually involved technical considerations. A paucity of evidence surrounds foot and ankle surgery. This study investigates the learning curve during a foot and ankle surgeon's first year, defined by functional outcome.

150 patients underwent elective foot or ankle surgery during the whole period. Preoperative and 6 month postoperative functional scores were compared between the first and second 6 month groups.

Functional improvement was greater, approaching significance, in the second group (p=0.0605). There was no difference for forefoot cases (p=0.345). Functional improvement was significantly greater in the second group with forefoot cases removed (p=0.0333).

A learning curve exists in the first year of practice of foot and ankle surgery, demonstrated by functional outcome. This is confined to ankle, hindfoot and midfoot, but not forefoot surgery.