AOFAS

AOFASClinicalRatingSystemCopyright1994bytheAmericanOrthopaedicFootandAnkleSocietyFoot&AnkleInternational/Vol.15,No.7/July1994ClinicalRatingSystemsfortheAnkle-Hindfoot,Midfoot,HalluxandLesserToesHaroldB.Kitaoka,M.D.;IanJ.Alexander,M.D.;RobertS.Adelaar,M.D.;JamesA.Nunley,M.D.;MarkS.Myerson,M.D.;MelanieSanders,M.D.ABSTRACTFourratingsystemsweredevelopedbytheAmericanOrthopaedicFootandAnkleSocietytoprovideastandardmethodofreportingclinicalstatusoftheankleandfoot.Thesystemsincorporatebothsubjectiveandobjectivefactorsintonumericalscalestodescribefunction,alignment,andpain.Orthopaedicsurgeonsarefacedwithabewilderingnumberofreportsinthemedicalliteraturethatareachallengetointerpretandapplybecausenostandardizedevaluationschemeisuniversallyusedoraccepted.Unlikethecasewithhipandkneejoints,fewoftheratingsystemsreportedfortheankleandfoothavebeenadoptedforusebysubsequentinvestigators.4,6,7,12-14Someevaluationschemesincorporatesubjectiveandobjectiveclinicalvariablesintoanumericalscale,suchastheforefootscoreforbunionette,7-9,15forefootscoreforbunion,6anklescores1,4,5,11,13heelscore,3tarsometatarsal14orresectionarthroplasty.7score,orankleinversioninjuryscale,12orintoagradednonnumericalscale,suchasexcellent,good,fair,andpoor.Othersincorporateonlysubjectivefactorsintononnumericalscale,andsomeincludebothradiologicandclinicalfactors.Insomecases,patientsareaskedtoratetheirownresultoftreatmentbyselectinganonnumericalgrade.Nonnumericalgradingusedincludescategoriesofexcellent,good,fair,poor;good,fair,poor;good,poor;good,goodwithreservations,failure;andsuccessful,unsuccessful.Clinicalresultsareoftenreportedasindividualfactorswithoutaggregationintoacompositescore.Sometimesnonnumericalgradesarereportedwithlimitedinformationaboutwhatcriteriawereusedtodefineeachgrade.Astandardratingsystemideallyallowsforthecomparisonofresultsofdifferentmethodsoftreatmentinpatientswiththesamedisorder.Italsoenablesthesurgeontofollowtheprogressofthepatientbeforeandatvariousintervalsafteraparticulartreatment.LogintoaccesstheMembershipDirectoryUsernamePasswordIdon'tknowmypasswordClinicalRatingSystem-AmericanOrthopaedicFoot&AnkleSocietyfile:///C|/DocumentsandSettings/deon//AOFASScore.htm(1of9)2006-11-1023:03:19Meetings,CoursesandEventsAboutAOFAS~BecomeaMemberEducationandTrainingOutreachandEducationFundProjectsSupportTheOutreachAndEducationFundClinicalRatingSystem-AmericanOrthopaedicFoot&AnkleSocietyThepurposeofthisstudywastodevelopandreportastandardratingsystemforthefootandankle.MATERIALSANDMETHODSAcommitteeoftheAmericanOrthopaedicFootandAnkleSocietyreviewedpublishedratingsystemsfortheankleandfootaswellassystemsusedinthehip,knee,spine,shoulder,wrist,elbow,andhand.Weconsidereddifferentwaysofrating,suchasaglobalscoreencompassingallregionsofthefootandankle,ascoreforeachindividualjoint,andaseparatescoreforeachtypeofoperation.Byconsensus,fourscalesweredevelopedfordifferentanatomicregions.Variousfactorsthoughttoreflecttheconditionoftheankleandfootwereconsideredaswellastherelativeweightofthesefactors,theuseofnonnumericalgrading(e.g.,excellent,good,fair,andpoor),andinclusionofradiologicvariables.Wedecidedthatthescaleshouldnotrequiretheuseofsophisticatedequipment,suchasaforceplateorfootpressuremeasurementsystem,andshouldnotbesocomplexthatitsusebyclinicianswouldbelimited.Itshouldalsobeapplicablefordifferentclinicalsituations,suchasevaluationofpatientsafterarthrodesis,implantarthroplasty,andligamentreconstruction.RESULTSWedevisedfourgradingscales,eachwith100possiblepoints.Noradiologicfactorswereincludedbecausewewantedthescorestobestrictlyclinical.Wealsodidnotassignnumericalvaluestoexcellent,good,fair,andpoorresults.Bothsubjectiveandobjectiveclinicalfactorsconstitutedeachscale.Itwasrecognizedthatjointsoftheankleandhindfootfunctionasacomplex.Forexample,inversionmotionofthefootinvolvesrotationofthesubtalar,talonavic-ular,calcaneocuboid,andanklejoints.Wethereforedevelopedacombinedankle-hindfootratingsystem.Thethreeotherproposedsystemswere(1)midfoot,(2)halluxmetatarsophalangeal-interphalangeal,and(3)lessermetatarsophalangeal-interphalangealscales.Ankle-HindfootScaleThisscalegradesankle,subtalar,talonavicular,andcalcaneocuboidjointlevelsandmaybeappliedtoanklereplacement,anklearthrodesis,ankleinstabilityoperations,subtalararthrodesis,subtalarinstabilityoperations,talonaviculararthrodesis,calcaneocuboidarthrodesis,calcanealosteotomy,calcaneusfracture,talusfracture,andanklefracture.Thisscaleisamodificationofaclinicalscalepublishedpreviously.4Ascoreof100pointsispossibleinapatientwithnopain,fullrangeofsagittalandhindfootmotion,noankleorhindfootinstability,goodalignment,abilitytowalkmorethansixblocks,abilitytoambulateonanywalkingsurface,nodiscerniblelimp,nolimitationofdailyorrecreationalactivities,andnoassistivedevicesneededforambulation.Fiftypointswereassignedtofunction,40topain,and10toalignment.Theankle-hindfootscoreisdetailedinTable1.Itisnotpossibletodetermineisolatedanklejointrangeofmotionclinically;therefore,dorsiflexionmotionandplantarflexionmotionaremeasuredwithagoni-ometerandd