Background: The Pain Catastrophizing Scale (PCS) is a measure of how patients emotionally respond to pain. It is composed of 3 subscales—rumination, magnification, and helplessness—which address intrusive thoughts of pain, expectations of negative outcomes, and inability to cope with pain. Our purpose is to compare baseline PCS scores with other baseline patient-reported outcome measures (PROMs) in patients with plantar fasciitis (PF) or chronic ankle instability (CAI). Methods: We retrospectively reviewed 201 patients who reported at least 1 pretreatment PCS subscore and were diagnosed with PF or CAI between 2015 and 2020 in a single fellowship-trained foot and ankle surgeon’s clinic. Demographics, comorbidities, treatments, other baseline PROMs (i.e., visual analog scale [VAS], Pain Disability Index [PDI], 12-Item Short Form Survey [SF-12], 8-Item Somatic Symptom Scale [SSS-8]), and postoperative outcomes were recorded. Results: The PCS total score and its subscores significantly correlated with the total score and/or subscores of each PROM. Higher PCS total score significantly correlated with worse VAS (P<.001), SF-12 mental (P=.007), PDI total (P<.001), and SSS-8 (P<.001) scores. Only the PCS magnification subscore was significantly greater among patients who did (n=41) undergo surgery (P=.043). Those who had previously undergone foot and/or ankle surgery had significantly higher PCS rumination ( P=.012), magnification ( P=.006), helplessness ( P=.008), and total ( P=.003) scores. Likewise, those with a history of substance abuse also had significantly higher PCS scores ( P=.005; P=.003; P=.006; P=.003). Conclusion: The correlations between PCS scores and other baseline PROMs indicate that strong pain catastrophizers with PF or CAI may be at risk for poor treatment outcomes. PCS scores could be used to help with treatment for such high-risk patients.

Introduction: While many patients benefit from nonoperative treatment of insertional Achilles tendinopathy (IAT), some elect for surgical debridement and reconstruction. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological parameters with failure of conservative management of IAT. Methods: A retrospective chart review was performed to identify patients who received either surgical or nonsurgical treatment of IAT at an academic institution from September 2015 to June 2019 (N = 226). Demographic and comorbidity data, and the presence and magnitude of relevant radiological parameters were collected and compared between the surgically (n = 48) and nonsurgically (n = 178) treated groups. Results: No significant differences could be detected between groups regarding demographic factors or previous procedures. The surgery group was significantly more likely to have evidence of Haglund’s deformity on clinical exam (83% vs 69%, P = .005), lower SF-12 physical scores (25.5 vs 35.5, P < .001), higher VAS pain scores (6.3 vs 5.3, P = .033), any mental illness (33% vs 20%, P = .044), and depression (27% vs 12%, P = .012). Discussion: Patients who received surgery for IAT were significantly more likely to have evidence of Haglund’s deformity on clinical exam, depression, higher VAS pain scores, and lower SF-12 physical scores. Both patients and surgeons should be aware of the higher rates of failure of conservative treatment in these patients. Level of Evidence: Level III

Category: Hindfoot Introduction/Purpose: While many patients benefit from non-operative treatment of insertional Achilles tendinosis (IAT), some require surgical debridement and reconstruction. While numerous studies have looked for factors that may contribute to the development of IAT, there is a lack of studies that identify factors that contribute to the need for surgical management. Identification of these factors could better inform physicians on the progression of IAT and could help guide doctor and patient decision-making. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological markers with the need for future surgical or non-surgical management of IAT. Methods: A retrospective chart review was performed to identify patients who received either surgical or non-surgical treatment of IAT at an academic institution from September 2015 - June 2019. Patients were identified using ICD-10 diagnosis codes for Achilles tendinosis, and all cases of non-insertional tendinosis were excluded (N=226). This sample was further separated into patients who received surgical treatment (n=48) and those who were managed conservatively without surgery (178). Demographic and comorbidity data was collected and compared between groups. Additionally, the presence and magnitude of radiological markers including Haglund's deformity, calcaneal enthesophytes, relevant calcaneal angles, and maximum cross- sectional tendon disease involvement on MRI were collected and compared between groups (Figure 1). A multivariate, binomial logistic regression model was then constructed in order to identify independent predictors of the need for surgical management. Results: There were no significant differences between groups in regard to age, sex, race, BMI, tobacco or alcohol use, hypertension, diabetes, arthritis, previous arthroplasty, or previous platelet-rich plasma injection. The surgery group was significantly more likely to have evidence of Haglund's deformity on clinical exam (83% vs. 69%; p=.005) and to have depression (27% vs. 12%; p=.012). Patients who received an ankle MRI were more likely undergo surgery (63% vs. 27%; p=.006), and patients treated surgically had a higher percentage of maximum cross-sectional tendon disease involvement on MRI (41% vs. 26%; p<.001). Multivariate logistic regression analysis showed that increased cross-sectional disease involvement was an independent predictor of the need for surgery, with involvement of at least 18% being significantly predictive of this need. Conclusion: Patients who received surgery for IAT were significantly more likely to have evidence of Haglund's deformity on clinical exam, have a previous diagnosis of depression, have received an MRI, and have a higher percentage of cross-sectional tendon disease involvement. Patients with at least 18% cross-sectional tendon involvement on axial MRI are more likely to go on to surgery and should therefore be counseled as such. Foot and ankle surgeons should use this information to facilitate shared decision-making regarding conservative versus surgical treatment of IAT.

Introduction Total elbow arthroplasty (TEA) is an increasingly popular surgical option for many debilitating conditions of the elbow. There currently exists a paucity of literature regarding patient and hospital factors that lead to inferior outcomes following TEA. The purpose of this study is to identify independent predictors of increased complication and revision rates following TEA. Methods The National Readmissions Database (NRD) was queried from 2011 to 2018 to identify all cases of TEA (n = 8932). Relevant patient demographic factors, comorbidities, and hospital characteristics were identified and run in a univariate binomial logistic regression model. All significant variables were included in a multivariate binomial logistic regression model for data analysis. Results Independent predictors of increased complication rates included age, female sex, Medicare and Medicaid payer status, medium bed-sized center, and 18 of 34 medical comorbidities (all P < .05). Independent predictors of increased revision rates included medium bed-sized centers, non-teaching hospital status, chronic pulmonary disease, depression, and pulmonary circulatory disorders (all P < .05). Conclusion This study identified several patient and hospital characteristics that are independently associated with both increased complication and revision rates following TEA. This information can aid orthopedic surgeons during shared decision making when considering TEA in patients. Level of Evidence Level III, retrospective cohort study.