Foot and Ankle Outcome Instruments: Missing the Target

Although developing PROMs is arduous and measuring their psychometric characteristics is even more so, the number of available PROMs has grown dramatically in the foot and ankle community over the past few years. The psychometric properties of foot and ankle PROMs vary considerably, which could explain why there are so many of them used in the literature. This review aims to shed light on the most commonly used PROMs in foot and ankle literature and assess the evidence supporting their use.

In this study, very limited evidence was found to support the use of most of the commonly used PROMs in foot and ankle literature, and no evidence was found that supports the use of the most common tool, the AOFAS Clinical Rating System. The quality of the studies examining PROMs was also questioned. Prior to making a conclusive determination regarding each instrument, however, additional research on the evidence is necessary. It is extremely challenging to perform systematic reviews comparing data across foot and ankle studies, and it is almost impossible to pool such data into high-quality meta-analyses. So, we need a foot and ankle score for measuring trauma-related outcomes, a score for measuring elective procedure outcomes, and a score for measuring pediatric foot and ankle.