Falls following foot surgery.

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If foot or ankle surgery is planned should these structures be strengthen before the surgery? Also, should special attention be paid to strengthening the toe flexor muscles following surgery since we know weakness in these muscles is linked to falls?
Below is an abstract from a recent paper.
Prevalence and Risk Factors of Postoperative Falls Following Foot and Ankle Surgery

Nicholas A Andrews 1, Matthew C Hess 1, Sean Young 1, Jared Halstrom 1, Kenneth Fellows 1, Whitt M Harrelson 1, Zachary L Littlefield 1, Abhinav Agarwal 1, Gerald McGwin 1 2, Ashish Shah 1
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• PMID: 35403465
  
• DOI: 10.1177/10711007221082644

Abstract

Background: No study has examined the incidence of risk factors for postoperative falls following foot and ankle surgery. We investigated the incidence and risk factors for postoperative falls in foot and ankle surgery using inpatient and outpatient population.
Methods: A single fellowship-trained foot and ankle surgeon instituted collection of a postoperative fall questionnaire at 2 and 6 weeks postoperatively. A retrospective review of 135 patients with complete prospectively collected fall questionnaire data was performed. Patient demographic information, injury characteristics, comorbidities, baseline medications, length of hospital stay, visual analog scale (VAS) pain scores were collected. After univariable analysis, a multivariable binary logistic regression was conducted to assess independent risk factors for postoperative falls.
Results: The median (interquartile range) age was 52 (21) and body mass index was 32.7 (11.1). A total of 108 patients (80%) underwent outpatient procedures. Thirty-nine of the 135 patients (28.9%) reported experiencing a fall in the first 6 weeks after surgery. In multivariable analysis, antidepressant use (adjusted odds ratio 3.41, 95% CI 1.19-9.81) and higher VAS pain scores at 2 weeks postoperatively (adjusted odds ratio 1.27, 95% CI 1.08-1.50) were found to be independent risk factors for postoperative falls.
Conclusion: This study found a high incidence of postoperative falls in the first 6 weeks after foot and ankle surgery. Baseline antidepressant use and higher 2-week VAS pain scores were associated with postoperative falls. Foot and ankle surgeons should discuss the risk of falling with patients especially those with risk factors.

 

Falls, especially in older people, can be lethal. The researchers don't seem to have looked at toe flexor strength in their study. Not sure why because increased toe flexor weakness is known to be factor in falls.
It's almost as if toe flexor strength should be ignored because it is not a factor that can be easily influenced.

 

As stated in my signature, I have an interest in a patented device called the "Novabow System". It is mainly concerned with helping to make the foot stronger and more flexible.

A good few years ago I took the Novabow concept to the head of the Podiatry Department of one of the UKs leading podiatry schools . He seemed to love the idea and felt that it could be used in conjunction with some forms of splint since a study on the effects of diabetic foot immobilization, that he had been involved with, showed almost no intrinsic musculature left after a few months of splint usage.

Back to planned surgery and it would appear that many types of lower limb procedures require a pre-op period of strengthening on the part of the patient. So for example surgeons ask knee or hip replacement candidates to strengthen their quads, glutes, ankle plantar flexors etc, but never any mention of the toe flexor muscles which are crucial to balance. Can anyone tell me why ?