Impact of COVID-19 on Pathology Presenting to a Foot and Ankle Clinic

CATEGORY: Other INTRODUCTION/PURPOSE: In our city, the COVID-19 pandemic led to a shelter-in-place ordinance, job loss, gym closures, and employees working from home. As a result, individuals adjusted their daily activities and exercise routines, potentially impacting the burden of foot and ankle disease. The purpose of the present study was to compare diagnoses made in an orthopaedic foot and ankle clinic during the months of the COVID-19 pandemic to diagnoses made during the same months of the previous year. METHODS: A retrospective review of new patients presenting to our group of four fellowship-trained orthopaedic foot and ankle surgeons was performed. Patients in the COVID-19 group presented between March 22, 2020 (the beginning of our shelter-in- place ordinance) and July 1, 2020. Patients in the control group presented during the same period of the previous year. Final diagnosis was characterized. Chronicity was classified as acute (symptom duration <= 1 month) or chronic (symptom duration > 1 month). Diagnoses were classified as fractures (e.g. ankle fractures, foot fractures) or activity-related (e.g. plantar fasciitis, ankle sprain). Pearson Chi-squared tests were performed to assess for differences in patient presentations between the COVID-19 and control periods. RESULTS: A total of 1,409 new patient visits were reviewed with 449 visits in the COVID-19 group and 960 visits in the control group. The COVID-19 group had a significantly higher proportion of ankle fractures (8.7% versus 5.4%; p=0.020) and stress fractures (4.2% versus 2.2%, p=0.031), but a smaller proportion of Achilles tendon ruptures (0.7% versus 2.5%; p=0.019). Similarly, the COVID-19 group had a higher proportion of acute injuries (35.4% versus 23.5%; p<0.001). No difference was seen between diagnoses classified as fractures or those classified as activity-related. Finally, the COVID-19 group had a higher proportion of acute activity-related injuries (16.0% versus 11.7%; p=0.023) and acute fractures (14.0% versus 8.4%; p=0.001), but a lower proportion of chronic activity-related injuries (22.5% versus 28.1%; p=0.025). CONCLUSION: The COVID-19 pandemic caused a marked shift in the pathology presenting to the orthopaedic foot and ankle clinic. There was an increase in ankle fractures, stress fractures, and acute injuries when compared to the previous year, and a decrease in Achilles tendon ruptures and chronic injuries. This shift may reflect both the adoption of different activities during the quarantine period and a reluctance to present to a medical environment for evaluation of non-urgent injuries.