Foot and Ankle International - 2026-07-06 - Journal Article
Predictors of Limited Weight-Bearing Dorsiflexion Following Total Ankle Arthroplasty.
Thomas GM, McCahon JAS, Dulitzki Y, Chen Z, Parekh SG, Daniel JN, Pedowitz DI
Topics
Key Takeaway
Preoperative clinical dorsiflexion was the only independent predictor of postoperative dorsiflexion after TAA, with 63.4% of patients failing to achieve ≥20° at mean 3.3 years.
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Summary
This study sought to identify preoperative predictors of limited weight-bearing dorsiflexion (<20°) following primary TAA in 175 patients over a 10-year single-surgeon series. Demographic variables, comorbidities, polyethylene size, and adjunctive soft tissue procedures including gastrocnemius recession and TAL showed no significant association with postoperative dorsiflexion. Multivariable logistic regression identified preoperative clinical dorsiflexion as the sole independent predictor; patients achieving full postoperative DF had significantly better FAAM-ADL scores (86.9 vs 70.0, P=.010) and were older (65.5 vs 61.5 years, P=.013).
Key Limitation
Single-surgeon, single-center retrospective design with no standardized preoperative dorsiflexion measurement protocol limits reproducibility and generalizability of the predictive model.
Original Abstract
BACKGROUND
Limited dorsiflexion (DF) after total ankle arthroplasty (TAA) is a challenge that has been associated with worse functional outcomes and lower patient-reported satisfaction. The purpose of this study was to identify predictive variables for limited DF following TAA.
METHODS
A retrospective cohort study was conducted on patients who underwent elective primary TAA between 2013 and 2023 by a single surgeon. Postoperative range of motion (ROM) was assessed using weight-bearing lateral radiographs obtained in maximal DF and plantarflexion (PF). Limited DF was defined as <20° and preoperative DF was based solely on clinical assessment (C-DF). Demographic variables, medical comorbidities, surgical history, and adjunctive procedures, including gastrocnemius recession and tendo-Achilles lengthening (TAL), were collected and compared between patients who achieved full vs limited postoperative DF. Additionally, Foot and Ankle Ability Measure activities of daily living subscale (FAAM-ADL) and visual analog scale (VAS) scores were collected. Multivariable logistic regression was performed to identify independent predictors of final DF.
RESULTS
A total of 175 patients were included in this study, with 111 (63.4%) demonstrating limited postoperative DF and 64 (36.6%) achieving full DF at a mean 3.3 years. Age was significantly greater in the full DF group (65.5 vs 61.5 years, P = .013). No significant associations were identified between body mass index / weight, tobacco use, diabetes, sex, medical comorbidities, polyethylene size, or adjuvant procedures and postoperative DF following TAA. Prior open reduction internal fixation was more prevalent in patients with limited DF ( P < .05), whereas postoperative FAAM-ADL scores were more favorable in the full DF group (70.0 vs 86.9, P = .010). Multivariable regression analyses identified full C-DF as the only significant independent predictor of improved postoperative DF following TAA.
CONCLUSION
Preoperative clinical dorsiflexion was the only significant independent predictor of postoperative dorsiflexion following TAA. A thorough preoperative discussion regarding anticipated postoperative motion can help establish appropriate expectations and potentially enhance patient satisfaction following TAA.