Keeping up With the Foot and Ankle Literature: A Practical “How-To”

In the era of evidence-based medicine, it is incumbent on us to stay abreast of the advances in foot & ankle (F&A) surgery that allow us to provide optimal care for our patients. While several works have suggested ways to keep up to date,^2,3 the 2 fundamental difficulties involve (1) the increasing volume of scientific literature and (2) time. Haynes et al. noted that even if a physician committed to reading 2 medical journal articles per day, in 1 year’s time they would fall 55 centuries behind. ¹ While that held true in 1979, the amount of published research has increased exponentially, making the task of keeping up to date even more difficult.

A busy surgeon simply cannot read it all, nor should they, as investigations are of variable quality and may not be applicable to their practices. Yet sustaining a truly evidence-based practice requires constant attention to the latest literature. We present a practical approach that is based on a tiered prioritization strategy and time-appropriate allocation. Furthermore, we offer some time-saving strategies applicable to the modern digital age. Although our strategies may not work for everyone, we have found this approach effective in overcoming the 2 inherent issues of volume and time that make keeping up to date a daunting task.

A tiered prioritization strategy (Figure 1) with appropriate time allocation is constructed by what we should know as practicing orthopaedic surgeons, what we need to know as F&A specialists and what we’d like to know given particular interests and applicability to our individual practices.

Figure 1.

Tiered prioritization strategy. Although most of our effort should be focused on the top tier foot and ankle journals, major medical journals as well as topics and researchers of interest should be routinely reviewed for content applicable to our practices.

• 1. Tier I: General Orthopaedic and Nonorthopaedic Medical Journals

We recommend reading scientific reports related to F&A surgery published in major general orthopaedic and medical journals in their entirety on a monthly basis. We should understand the conclusions (and nuances) of investigations related to our field deemed of significant importance and scientific quality to warrant publication in general orthopaedic journals. These works often represent knowledge applicable to most orthopaedic surgeons regardless of subspecialty training. Similarly, publications in high-impact medical journals pertinent to F&A surgery should be thoroughly reviewed. Based on publication in nonorthopaedic journals, these investigations typically report important and broad-reaching scientific findings on exceedingly common F&A pathology. If our orthopaedic colleagues in other subspecialties and/or our medical colleagues are abreast of major developments in F&A surgery, we as F&A specialists most certainly should be as well.

• 2. Tier II: F&A Journals

We recommend reading all scientific reports in the top tier F&A journal(s) either in their entirety or in abstract form on a monthly basis. Although works of higher-level evidence and more broad-reaching implications to F&A practice should probably be read in their entirety, review of abstracts alone for many articles may be sufficient enough for practicing surgeons to understand an investigation’s significance and potential impact on their clinical practice.

• 3. Tier III: Areas of Interest

Within F&A surgery, nearly all of us have particular areas of interest whether it be reconstruction, trauma, or arthroplasty for example. We recommend searching via PubMed or Google Scholar these specific topics on a quarterly basis. This is an effective means of finding high-quality, impactful studies on a particular topic published in journals not regularly perused.

• 4. Tier IV: Researchers of Interest

Certain researchers (who may even be colleagues, collaborators, or friends) may frequently publish investigations in an area of interest. Search for their works on a semiannual basis to see what they have recently published.

Although accomplishing the above takes time (and sometimes perceived as time away from other obligations), it should be considered an occupational requirement to keep up with the literature in a regimented way if we want to practice evidence-based medicine. However, the time commitment extends beyond just the time it takes to read articles, as sifting through newly published works and finding the appropriately pertinent articles can be a significant time investment as well. Luckily, technological tools on our computers and smartphones offer some solutions to help ease this process. We have therefore come up with a few ways to use technology to efficiently and effectively find and read appropriate articles.

• 1. News aggregators and RSS feeds:

Really Simple Syndication (RSS) was developed to permit content to be consolidated into 1 location from multiple sources and permits news aggregators to monitor websites for new content which can be presented to the user. An example of one author’s News Aggregator can be found in Figure 2. Surgeons who use news aggregators can choose to review it weekly or monthly and scan journals for abstracts and articles worth reading in more detail. Some news aggregators can make it very easy to filter by keyword and allow more targeted monitoring of major journals for F&A-relevant topics. A simple online search using terms “news aggregator”, “RSS feeds” and “medical journals” or “surgical journals” will easily identify numerous well-designed applications. Most major journals have their unique RSS feed easily found on their website, which the user can then add to their news aggregator.

Figure 2.

A screenshot of a news aggregator application used by the authors to aggregate RSS feeds from multiple sources. This permits easy scanning of the table of contents of journals; keyword filtering is one of numerous other features that make keeping up with the literature easy and efficient.

• 2. Text-to-Audio Readers:

It can be hard to find the time to sit down and read. For several years now, we have used smartphone applications that will read aloud PDF files to maximize efficiency, allowing us to listen to manuscripts while exercising or driving for example. Although care must be taken to avoid undue distraction, text-to-audio readers are effective means of multitasking and time-management. A variety of text-to-audio readers are available on most smartphone application marketplaces (eg, iPhone App Store).

• 3. Twitter/Social Media:

Social media is perhaps the easiest way to follow the latest research from specific investigators. We subscribe to the Twitter feeds of those who promote their work online, and this allows us to easily stay abreast of their latest works. Furthermore, journals are increasingly encouraging authors to disseminate their works on Twitter using infographics. Subscribing to twitter feeds from critical journals is yet another way to stay current. Some journals frequently post short infographic segments on their latest featured articles, allowing users to quickly peruse and read further if there is interest in the topic.

• 4. Podcasts:

The American Orthopaedic Foot & Ankle Society and other orthopaedic subspecialties, as well as many journals, publish weekly or monthly podcasts in audio/visual format. These can be an easy way to stay current. Although different formats exist, most offer an in-depth look into recently published scientific manuscripts often by the authors themselves.

All in all, sustaining a truly evidence-based practice of foot and ankle surgery requires near constant attention to the latest literature. Although there is more information being published than ever before, there are also a tremendous number of tools to make filtering through this information easier. Most importantly, we recommend making a schedule and sticking to it. Staying current requires a slow and steady commitment with time set aside for periodic review. We owe it to our patients to have command over the body of evidence that informs our decisions and recommendations for their care.

Supplemental Material

sj-pdf-1-fao-10.1177_24730114221095512 – Supplemental material for Keeping up With the Foot and Ankle Literature: A Practical “How-To”

Supplemental material, sj-pdf-1-fao-10.1177_24730114221095512 for Keeping up With the Foot and Ankle Literature: A Practical “How-To” by Eitan M. Ingall, John Zhao and John Y. Kwon in Foot & Ankle Orthopaedics