The results of a national survey of surgeons and physiotherapists regarding physiotherapy practice after foot and ankle arthritis surgery

Philippa Dolphin, Sarah Johnson-Lynn

Introduction: The lifetime prevalence of symptomatic ankle arthritis is 3.4% (Murray, 2018) and symptomatic mid- and hindfoot arthritis affects 1 in 6 older adults (Thomas, 2015). The majority of this disease burden falls on women, manual workers and those with higher markers of socioeconomic deprivation (Roddy, 2015). There is no agreed pathway in the UK for physiotherapy after foot and ankle arthritis surgery and there is little evidence to guide treatment. This has led to the role of physiotherapy in foot and ankle conditions being made a JLA top 10 priority.

Method: A survey of current physiotherapy practice following foot and ankle arthritis surgery was conducted in the UK via the BOFAS AHP network and a paired questionnaire was disseminated to the BOFAS surgical membership. There were 106 surgeon questionnaire responses, 95% from consultant members. There were 26 responses to the AHP questionnaire, 92% of responses being from band 7 and 8a specialist foot and ankle or lower limb physiotherapists.

Results: Most surgeons felt that the most important purpose of post-operative physiotherapy was to normalise gait (60% after ankle fusion, 64% after foot fusions), however physiotherapists were equally likely to believe that managing patient expectations was most important (29%; 29%). Only 35% of units employed a specialist foot and ankle physiotherapist and 32% of surgeons felt that their patients had inadequate access to foot and ankle physiotherapy. 18% of units have rehabilitation protocols for patients after foot and ankle fusion surgery. Most patients receive 5 or fewer sessions of physiotherapy post-operatively (73% of ankle fusion and 78% of foot fusion patients).

Conclusion: Most UK patients will receive physiotherapy after foot and ankle fusion surgery, but access is variable and most centres do not use a protocol.