Foot & Ankle Orthopaedics is an open access, peer-reviewed journal. All accepted articles are made freely available online immediately upon publication, are published under a Creative Commons license, and hosted online in perpetuity.

Publication costs of the journal are covered by the collection of article processing charges which are paid by the funder, institution or author of each manuscript upon acceptance. There is no charge for submitting a paper to the journal.

For general information on open access at Sage please visit the Open Access page or view our Open Access FAQs.

If, after peer review, your manuscript is accepted for publication, a one-time article processing charge (APC) is payable to cover the cost of publishing, paid by the funder, institution, or author. There is no charge for submitting a manuscript.

Any submissions on/after January 1, 2023, will incur the updated pricing structure, outlined below. There are no fees payable to submit to this journal. Article processing charges are only assessed upon acceptance.

The article processing charge (APC) for AOFAS members and articles cascaded from FAI will be $800.

The article processing charge (APC) will be $1,200 for direct submissions from non-members.

Letters to the Editor (under 750 words) will not be charged any APC.

Revisions will be offered the rate from the first submission.

The article processing charge (APC) is payable when a manuscript is accepted after peer review, before it is published. The APC is subject to taxes where applicable. Tax-exempt status can be indicated by providing appropriate registration numbers when payment is requested. Please see further details on tax-exempt status here.

For general information on open access at Sage please visit the Open Access page.

Authors may be eligible for discounts to their APC via open access agreements that Sage has with participating institutions. Discounts depend on the terms of the agreement, find out if your institution is participating by visiting Open Access Agreements at Sage. Eligibility is determined by the corresponding author’s affiliation at acceptance matching an agreement.

Your article may be eligible for a full or partial waiver due to our participation in initiatives to increase accessibility to publication across the international academic community. More information about discounts and eligibility.

Your article must be within the scope of the journal and be of sufficient quality. If not, it will not be reviewed. Please read the journal’s Aims and Scope to see if your article is appropriate.

The manuscript must be your original work, you must have the rights to the work, and you must have obtained and be able to supply all necessary permissions for the reproduction of any copyright works not owned by you, including figures, illustrations, tables, lengthy quotations, or other material previously published elsewhere.

Preparing Manuscript

Manuscript Body

Manuscripts should be organized in the following order: Title, Abstract, Level of Evidence (Clinical Research) / Clinical Relevance (Basic Science), Keywords, Introduction, Methods, Results, Discussion, Conclusion, References.

Introduction

Establish relevance of question:

• Why is study important?
• Why is question interesting or controversial?
• What is the gap in the literature you’re filling? 
• Do not repeat the same in the Discussion

Methods

The Methods section must define the period during which the study was conducted, the specific criteria for inclusion and exclusion of patients, and the duration of follow-up. For retrospective studies, all patients who meet the inclusion/exclusion criteria in the specified time period should form the study population and the reasons for any additional exclusions should be reported (i.e. death, loss to follow-up, study withdrawal, etc.).

PROMs should be reported as summarized in A Short Primer on the Reporting of Patient-Reported Outcome Measures in Clinical Studies, Pinsker et al.; downloadable here.

Provide enough details to replicate your procedures. In particular, surgical techniques must be described well enough so another surgeon can reproduce the procedure. 

Considerations for the Statistical Analysis section

Please refer to the Author Guidelines at JAMA Network “Statistical Methods and Data Presentation” section at https://jamanetwork.com/journals/jamanetworkopen/pages/instructions-for-authors#Ref1 for a detailed set of specifications and principles that FAI and FAO are aiming to achieve in the submissions. Furthermore, FAI and FAO endorse the guidelines (as mentioned in the above JAMA Network link) in the publication ‘Reporting statistical information in medical journal articles’ by Cummings and Rivara (2003). [Cummings P, Rivara FP. Reporting statistical information in medical journal articles. Arch Pediatr Adolesc Med. 2003;157(4):321-324. doi:10.1001/archpedi.157.4.321.] 

Briefly, the Statistical Analysis section must describe:

• Whether the analysis is framed as exploratory or hypothesis-testing (see JAMA source above for explanation)
• All analyses performed in the study including demographic and sample characteristics for the study population and any comparative groups (e.g. group means, standard deviations). 
• How missing data was treated (e.g. imputation, excluded from analyses)
• If performed, correction for multiple hypothesis testing (e.g. Bonferroni) and how it is expressed in the Results
• The software used for analysis

STATISTICAL SAMPLE SIZE CALCULATION GUIDELINES

With regard to sample size for a study, we recommend:

1. Inclusion in methodology: In general, research submissions should detail their sample size calculation in the methods section and specify whether it was performed a priori or post hoc. In certain contexts, this may not be necessary, including exploratory or descriptive studies, pilot studies, and quality improvement initiatives. The study research question and objectives should be framed accordingly, and the sample size should be sufficient to provide meaningful insights. Please consult the JAMA Network source above for further detail regarding which types of studies require a priori and post hoc power analyses.
2. Acknowledging absence of an a priori calculation: If an a priori sample size calculation was not conducted, this omission should be highlighted in the discussion as a methodological weakness. As noted above, authors should supply in tables sufficient aggregated results (eg, group means and sample sizes) for readers to independently perform a post-hoc power analysis.
3. Addressing underpowered studies: If a sample size calculation indicates a study is underpowered, this should be mentioned in the study limitations along with details regarding the necessary number of subjects to ensure the research has adequate power. 

These recommendations aim to enhance the transparency and reliability of research through careful consideration of sample size and power analysis.

We recommend that authors use the following UCSF "sample size and power calculation" web page: https://data.ucsf.edu/research/sample-size.

Reporting and Discussion of Results 

Ninety-five percent confidence intervals must be calculated for point estimates (e.g. hazard ratios, odds ratios) whenever the results of survivorship or logistic regression analysis are given in the text or in graphs. Authors are encouraged to use 95% confidence intervals in addition to or instead of standard deviations when reporting results. If presenting confidence intervals other than 95% (e.g., 90%), this decision must be justified.

The statement that "no significant difference was found between two groups" cannot be made unless an a priori power analysis was performed and the value of alpha or beta is reported. In most cases, a sufficient number of patients (depending on the group differences in the main outcome, which can be expressed as an effect size) with the conventional alpha=0.05 with power=0.80, and often more, in each group is required to make such a statement. If no such power study was done and sufficient sample is not present, the author must state: "With the numbers available, no significant difference could be detected."

The term ‘significant’ should only be used to describe statistical significance and should be reported along with a P value.

The word "correlation" requires reporting of the Pearson correlation coefficient (r) or Spearman rank correlation (rs) (when assumptions of parametric analysis are not met). 

Results

Provide a detailed report on the data obtained during the study

General outline for clinical studies:

Paragraph(s) 1

• Demographics, baseline characteristics (Table(s) 1)
• Participant flow (FIGURE 1)

Paragraph(s) 2

• What did you find in terms of Primary Objective? (Table/Figure 2)

Paragraph(s) 3

• What did you find in terms of secondary objectives?

Paragraph(s) 4

• Sensitivity analyses, exploratory aims

Tables and text should complement each other, not repeat each other.

• Summarize key point in text, then refer to table.
• If table can be summarized in 1 sentence, delete the table.

Discussion

Paragraph 1: General summary statement of primary aim and primary findings.
Do not paste in all results. Results should be in Results and not appear first in Discussion!

Paragraph(s) 2: How do results fit with current literature?

• What are differences between this study and others?
• Speculate on why your findings differ.
• Summarize directions of the literature, not each and every manuscript.
• Reference source documents when possible.
• Claims of priority (“This is the first…”) must be backed up.

Paragraph(s) 3

• Balanced (humble) analysis of strengths and limitations
• If study is underpowered, the discussion should specify how many subjects needed to ensure the research has adequate power.
• Generalizability
• Subjects: All patients vs Women only, Men only
• Geography/Culture: Women in Rio vs Women in Alaska Setting: Tertiary Center/Expert Surgeon vs Generalist

Conclusion

Paragraph 4

• Implications of the Findings
• Possible mechanisms
• What is the meaning for:
• Patients 
• Providers

Legends

All artwork (figures and tables) submitted must have text included here, listed in order. Explain what each illustration shows rather than simply defining it. Give the amount of magnification of all photomicrographs. Define all arrows and other such indicators appearing, when necessary. If an illustration is of a patient who is identified by a case number in the text or table, include that case number in the legend. If a piece of artwork has been published elsewhere prior to this article and permission to include it has been granted, include proper attribution in the figure legend here.

What We Publish

Type of Article	Number of Words: Manuscript	Number of Words: Abstract	Figures	Tables	References
Clinical or Biomedical Scientific Manuscript	3,000	300	8	4	No limit
Short Scientific Report	1,200	225	3 total figures &/or tables	3 total figures &/or tables	10
Systematic Review / Meta-Analysis	3,000	250	4	4	No limit
Contemporary Review	4,000	n/a	10	3	No limit
Case Report	1,000	n/a	8	4	8
Technique Tip	1,000	n/a	8	4	8
Letter to the Editor	400	n/a	1 total figure or table	1 total figure or table	5

Short Scientific Report 

Short scientific reports are suitable for the presentation of research that presents preliminary data on novel treatments, extends previously published research including the reporting of additional controls, confirmatory results in other settings or even patients from the same cohort. Authors must clearly acknowledge any work upon which they are building, both published and unpublished. The Editor may ask authors to convert a full-length submission to a Short Scientific Report for the purposes of publication. Reviews, case reports, and technique tips are not considered for publication under this category.

Briefly summarize the results of original data. Each short scientific report is considered a scientific publication; authors must meet all requirements regarding responsible conduct of research (eg., appropriate IRB approval, data integrity, data retention).

Short scientific reports are limited to 1200 words with 3 figures and/or tables (not counting the title page, abstract, references, or legends). We allow a maximum of 10 highly relevant references. Online supplementary materials are permitted. Abstracts are limited to 225 words and include Background, Methods, Results, and Conclusion. The text body should include the following truncated sections: Introduction, Methods, Results, Discussion/Conclusion with enough detail or appropriate references to help others reproduce the investigation. Include Clinical Relevance for basic-science articles or Level of Evidence for clinical research articles. Keywords should describe the information contained in the paper, including any terms unique to the paper’s subject. Article title needs to end with "A Short Report."

Scientific Manuscripts

Maximum Limits: Text Body: 3,000 words, Abstract: 300 words, 4 Tables, 8 Figures

Total Ankle Arthroplasty (TAA) Manuscripts

1. TAA manuscripts must have a minimum of two-year follow-up for all patients in the study. Complications or implant issues can be reported with shorter follow-up. All repeat surgeries must be documented for all time points from the time of the index TAA.
2. Repeat surgery can be reported individually or as a series of events. The authors should outline which method was used. 
3. Non-surgical complications (such as DVT, pulmonary embolism or infection treated by antibiotics) should be documented.
4. The template below should be used as a guide for authors in reporting complications resulting in reoperation(s). This is based on the COFAS Ankle Arthritis Study Group coding system for reporting reoperations. Overlap will occur for some of these categories as individual patients may have had more than one re-operation. The intent is to distinguish between different types of complications resulting in reoperation (instead of simply reporting that a certain number of patients in a study had re-operations).
   1. At the time of the index procedure
   2. After the index procedure
   1. One stage TAA revision to TAA
   2. Two stage TAA revision to TAA
   3. Conversion to “long term” cement spacer
   4. Conversion to arthrodesis
   1. Tibia
   2. Talus
   3. Both tibia and talus revised to TAA
   4.  Removal of components and conversion to arthrodesis
1. No reoperation
2. Hardware removal related to TAA (e.g. medial malleolus screw(s), fibular plate)
3. Subsequent operative treatment related to TAA but not involving TAA components(e.g. osteotomy, fusion of other joint(s) of the foot, ligament repair/reconstruction)
4. Operative treatment of periprosthetic fracture(s)
5. Debridement of gutter or heterotopic ossification with retention of components
6. Polyethylene liner exchange for polyethylene wear or fracture
7. Operative treatment of postoperative arthrofibrosis(e.g. joint debridement +/- capsulotomy, Achilles lengthening, PE liner exchange
8. Debridement +/- grafting of osteolytic cyst(s)(with retention of metal components +/- polyethylene exchange)
9. Operative treatment of superficial infection or incision problem(e.g. I & D, secondary closure
10. Operative treatment of deep infection requiring debridement(+/- polyethylene liner exchange but NOT removal of metal components)
11. Deep Infection requiring removal of ALL components
12. Revision of metal components because of implant failure(e.g. aseptic loosening, subsidence, malposition, implant fracture----not for infection)
13. Amputation related to complications from TAAState reason(s): pain, infection, vascular compromise, failed prior treatments, patient choice, etc.

Randomized Controlled Trials (RCTs)

Randomized Controlled Trials (RCTs) must be prospectively registered in a publicly searchable clinical trials registry before considering review for publication from 1 January, 2020. RCTs, which started after the date of electronic publication of the editorial policy for Foot & Ankle International (FAI) in the transition period in 2019, as well as RCTs with satisfactory evidence of starting before electronic publication of the editorial policy for FAI, shall be allowed retrospective registration in a publicly searchable clinical trials registry prior to review and potential publication. The Editorial Board, however, will reserve the right to make rare exceptions in the event of unusual studies in extenuating circumstances following guidance from the Editor in Chief with an explanatory note from the authors regarding the reasons and an Editorial note for the exception, published as a foot note to the article.

Biomechanical Scientific Manuscripts

Submit biomechanical manuscripts under Basic Science and include a Clinical Relevance statement with abstract.

Biomechanical Models: All biomedical science models should represent clinically relevant and realistic situations. With biomechanical studies, in particular, the editors strongly discourage the use of surrogate Bone models (e.g., Sawbones) except as detailed below:

• Method development for biomechanical testing using actual bone.
• Determining mechanical properties and/or mechanical performance of an implant that exclude the mechanical properties and/or mechanical performance of the implant-sawbones interface.
• Determining mechanical properties and/or mechanical performance of different implant-bone constructs with anatomically (geometrically) representative sawbones models that are validated for mechanical properties and implant-bone interface properties.
• Bone anatomy related geometric studies (e.g., osteotomy correction, surgical navigation registration, certain imaging investigations)

In addition, other biomechanical studies have been published periodically that have inaccurate models to represent clinical reality. For example, an Achilles transection model is very different from a clinical rupture with significant shredding of tissue at the rupture site. In this case, investigators try to simulate an Achilles tendon rupture more validly (i.e., some degree of shredding at the damaged tendon site) so the findings can mirror clinically relevant and realistic situations.

Meta-analysis / Systematic Review

Submit meta-analysis / systematic reviews under clinical research. Do not include Level of Evidence with the abstract.

Systematic reviews and meta-analysis techniques are used to review and pool data obtained from high quality studies usually with Level I or II evidence. These techniques require determination of a specific health care question, selection of studies which meet research methodology and quality standards, and then application of rigorous methodology to minimize error, bias, and inaccurate or misleading conclusions. It is recommended that authors have or obtain expertise in these types of studies and plan their methodology accordingly. Working with an experienced librarian and statistician with specialized skills is highly recommended. Studies which conclude that the quality of existing literature is not adequate (poor) and that more studies are needed, provide little useful information to the reader and will seldom be accepted for publication.

Contemporary Reviews

A Contemporary Review serves to educate the readership about conditions and/or procedures. Covered topics typically have a narrow focus or describe new procedures associated with limited clinical evidence. Word count is 4000 words excluding references. Do not include abstract or Level of Evidence.

Authors can contact the Senior Editor for Contemporary Reviews, Christopher P. Chiodo, MD, to find out if FAI or FAO have recently published a review article on that topic, if there is a similar submission in progress or if the subject matter is considered in scope for the journals. Email Dr. Chiodo at [email protected] (cc: FAO[email protected]) to inquire about your idea.

Submit completed papers directly to the journal at https://mc.manuscriptcentral.com/fao. All submitted Contemporary Review Articles will be considered by the Contemporary Review Editors

Format of a Contemporary Review

1. Introduction. Present a brief overview and purpose statement - Why is this condition worthy of a review?
2. Background of the condition(s). Summarize relevant background information. This may include a historical survey, basic science, pertinent clinical studies, and current controversies related to the condition.
3. Presentation. Briefly describe the typical clinical presentation of the condition(s).
   1. history
   2. physical examination
   3. radiographic/imaging and laboratory findings
4. Treatment. Describe both non-operative and operative treatment options.
   1. This section can be divided into subsections (e.g. addressing a treatment option or set of treatment options). Each subsection should then be comprised of one or more paragraphs. The introductory topic sentence(s) of each subsection should neatly frame the issue. When possible, this should be a specific, direct query that begs an affirmative or negative response. Sometimes the issue is framed with a broad, generalized question that is then broken with specific details in a succession of paragraphs.
5. Complications. If applicable, describe the relevant and most common complications associated with a surgical procedure or non-operative treatment.
6. Authors’ preferred method of treatment (optional). If applicable, this section can include your preferred treatment for a described condition. Please make sure to include your rationale and include any technique tips that you feel may help the reader.
7. Summary of the Main Points. Include four to eight main points of your manuscript. These may include treatment options with a growing body of evidence in the literature. Significant, unresolved controversies may be included with a brief discussion of the opposing viewpoints.
8. References. Formatted in AMA format per Foot & Ankle Orthopaedic guidelines. Try to use only recent or essential references.
9. Figures and Legends: A key feature of the Contemporary Reviews is to illustrate anatomic pathology, key imaging findings and surgical technique.
   1. Maximum Number of Tables: 3
   2. Maximum Number of Figures: 10

Case Reports

VERY FEW CASE REPORTS ARE ACCEPTED FOR PUBLICATION.

Case reports must either offer new information that has been previously unpublished, offer completely new information or information that will change the current practice patterns of our readers. Entities that are unique in and of themselves bizarre, or common, will NOT be accepted as case reports.

Case reports must contain the following sections: Introduction, Case Report, Discussion, and Summary/Conclusion.

References are limited to 8 or fewer.

Technique Tips

Authors are encouraged to submit Technique Tips only when they possess substantial evidence demonstrating the procedure's efficacy and superiority to alternatives (e.g., no treatment, non-operative treatment, other surgical approaches). Procedures that have been performed only a few times and appear to work are generally not ready for submission. In contrast, submissions are appropriate when authors have performed the procedure extensively, thereby gaining a comprehensive understanding of its optimal indications, procedural nuances, appropriate rehabilitation, post-procedure care, potential unique complications, and clinical outcomes. Such detailed reports can be extraordinarily beneficial to other surgeons. Our primary objective is to enhance patient care, and we rely on authors to submit Technique Tips only when they are convinced that the procedure has significantly benefited their patients.

Submissions for Technique Tips should adhere to the following structure and content requirements:

1. Introduction: A brief focused introduction that discusses the clinical problem leading to the utilization of the process, procedure, or diagnostic technique.
2. Indications and Contraindications
3. Technique: A detailed description of the technique or examination, including illustrations and post-procedure care/rehabilitation guidelines.
4. Complications: A detailed description of any known unique complications and/or strategies for mitigation.
5. Discussion/Conclusion: A highly focused discussion and conclusion.
6. References: Limited to 8 or fewer.
7. Figures: Sufficient for complete reproducibility.

Most accepted Technique Tips will be requested to submit a companion video.

Large Language Models (LLM) evaluations

AI/Chatbot Evaluation Manuscript Checklist

For studies evaluating AI tools (e.g., ChatGPT) in orthopedic education or clinical guidance. This checklist is intended to promote clarity, rigor, and reproducibility in AI tool evaluations submitted for publication.

Manuscripts that do not meet these minimum criteria may be returned without peer review.

1. Chatbot Version and Timing
   Specify which model used (e.g., ChatGPT 3.5, GPT-4)
   Report date(s) the chatbot was queried
   Acknowledge that responses may change over time (non-static outputs)
2. Target Audience and Evaluation Criteria
   Identify the intended audience for the chatbot responses (e.g., patients, clinicians).
   Ensure evaluation methods are appropriate for the intended audience (e.g., readability for patients, clinical accuracy for providers).
   Describe how response quality was assessed (e.g., using a structured rubric, grading scale, or categorical definitions).
3. Reference Standard and Validation Method
   Define the reference standard used to assess accuracy (e.g., clinical guidelines, standard textbooks, expert consensus).
   Describe how agreement was determined among reviewers (e.g., scoring thresholds, consensus discussion, Delphi process).
   Report interrater reliability, if applicable (e.g., kappa statistics).
4. Question Selection and Relevance
   Clearly describe how questions were selected (e.g., based on literature, patient forums, clinical experience).
   List the sources reviewed (e.g., top websites, FAQs, databases).
   Justify why these questions are representative of common or important clinical concerns.
5. Limitations and Scope
   Clearly disclose the limitations of the AI model (e.g., lack of source attribution, hallucinations, or reliance on outdated training data).
   Avoid overstatement of chatbot capabilities (e.g., refrain from using terms like “unbiased” or “clinically validated” unless supported by structured validation).
   Acknowledge that findings reflect a specific version at a single time point, and are not generalizable across model updates.
6. Study Design and Evidence Level
   Accurately classify the Level of Evidence. These studies are typically Level V under JBJS standards.
   State whether the study is exploratory, descriptive, or hypothesis-generating, and clarify that it is not a validation study unless validated against a defined clinical standard.

Clinical Trial Protocol

1. Definition & Scope

   FAO will consider prospectively registered, ehtically approved protocols of randomized or other prospective interventional trials that address clinically meaningful foot and ankle problems.

   Manuscripts must be submitted before  more than 25 % of the target sample is enrolled.
2. Length & Layout

   Component	Limit (with key notes)
   Structured Abstract	≤ 300 words – include Background, Objectives, Trial Design, Methods, Ethics & Dissemination headings
   Main Text	≤ 3000 words – include Introduction, Methods, Ethics & Dissemination, Trial Status headings
   Tables/Figures	≤ 6 combined – must include one SPIRIT 2025 schedule diagram
   References	≤ 50 references

   Formatting follows standard FAI requirements: 12‑point font, double‑spaced text, 1.25 in side margins, consecutive line numbers and bold‑underlined title.

   3. Mandatory Submission Package

   Upload the manuscript plus a minimum of the following six supplementary files; incomplete packages will be returned without review.

   1. Trial registration in an ICMJE-accepted clinical trials registry (registry URL/ID on title page).
   2. Ethics committee approval letter (PDF).
   3. SPIRIT 2025 checklist (Supplementary File 1).
   4. Dated Statistical Analysis Plan (SAP) (Supplementary File 2).
   5. ICMJE compliant data‑sharing statement inside the manuscript and as Supplementary File 3, if lengthy.
   6. Conflict of Interest
   1. FAI/FAO Disclosure Forms (Updated February 2026) completed for all investigators, AND
   2. Per Spirit 2025 guidelines: disclose the role of trial sponsor and funders, if any, in study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.

   Additional supplementary files may describe detailed operative techniques, statistical code, or include additional figures.

   4. Methods Section - Minimum Content

   • Protocol version control (must reference version approved by ethics committee)
   • Trial design, setting, eligibility, interventions (dose, timing, surgeon qualifications).
   • Randomization & allocation concealment methods.
   • Blinding plans (or rationale for absence).
   • Primary & key secondary outcomes with measurement timing and minimal important difference.
   • Sample size calculation (effect size, power, α, attrition).
   • Detailed data handling and missing data strategy (reference to SAP).
   • Monitoring/harms reporting procedures.
   • Explicit statement of enrollment status at time of protocol submission to FAO (e.g., "At the time of submission, X participants have been enrolled out of a target sample of Y participants [X%]").
   • Patient/public involvement description (if applicable)
   • SPIRIT 2025 schedule figure in TIFF, JPG, or Postscript.

   Extensive background narrative or operative minutiae should be moved to Supplemental files

   5. Peer Review Process

   Each protocol will be evaluated by a biostatistician and/or an Associate Editor using an FAO protocol checklist aligned with SPIRIT.

   6. Post-Publication Commitments

   Investigators agree to submit primary results to FAI or FAO within 12 months of study completion (last patient, last visit for primary endpoint), regardless of results. Negative or null results will receive equal consideration for publication

   7. Amendment Reporting: Authors must record every protocol amendment in the public trial registry within 30 days. If an amendment changes the trial’s scientific interpretation - for example, adds a new primary outcome or materially alters the sample size calculation, the authors should include a clearly labelled amendment table in the eventual Results section of related manuscripts. FAO will not routinely republish the full protocol.

Letter to the Editor

Letters may have no more than 3 authors. The text should include the full name, academic degrees, and a single institutional affiliation for each author and the email address for the corresponding author.

Letters discussing an article in this journal should be submitted within 4 months of publication of the article in print. Letters received after 4 months will rarely be considered. Letters should not exceed 400 words of text, one (1) figure or table and 5 references (including a required citation to the related article). All data presented must be fully citable and cited in the supporting reference list (unpublished data must not be described in the letter).

These submissions are subject to minor editorial alterations, may be shortened without the authors' approval, and are published both in print and on the journal website.

The editor routinely invites the author(s) of the related article to respond in writing. Letters that include specific questions for the original article's authors are prioritized for publication. Published letters are accompanied by either a reply from the original authors or the statement "Reply declined."

Letter in Reply

Replies by authors should not exceed 400 words of text, one (1) figure or table, and 5 references (including a required citation to the related article). The text should include the full name, academic degrees, and a single institutional affiliation for each author and the email address for the corresponding author. Replies need to be submitted within 30 days, or the letter to the editor may be published without an author reply with the statement "Reply declined."

Database Study Guidelines Summary

FAI and FAO welcome studies using large electronic health record (EHR), claims, and administrative databases. Because these data sources have well-known strengths and limitations, both journals have adopted shared methodological standards and journal-specific thresholds to help authors prepare rigorous manuscripts and choose the right venue for their work.

This summary introduces the key concepts. The full instructions to authors provide complete requirements, examples, rejection criteria, and specifications for supplementary materials. Authors should consult the full document before submitting.

The full instructions to authors are available here.

Choosing Your Journal: The Level-of-Inference Distinction

The central question is: What level of clinical inference do your data and outcomes support?

Foot & Ankle International (FAI) publishes clinical database studies that support decisive surgical inference. Primary outcomes must be procedure-confirmed (e.g., revision, reoperation, implant removal, arthrodesis, mortality, or procedure-confirmed complications such as infection requiring surgical debridement). Conclusions should inform surgical decision-making or patient counseling.

Foot & Ankle Orthopaedics (FAO) publishes clinical database studies that provide population-level insights and hypothesis-generating findings. Primary outcomes may be defined by diagnosis codes, healthcare utilization measures, or administrative endpoints. Conclusions must acknowledge the limited clinical inference inherent in these data.

Studies based primarily on diagnosis codes or indirect outcome measures are generally better suited to FAO. Studies with procedure-confirmed endpoints and rigorous laterality attribution are better suited for FAI.

At a Glance

	FAI	FAO
Mission	Decisive surgical inference through procedure-confirmed endpoints	Population-level insights and hypothesis-generating findings
Primary outcomes	Procedure-confirmed (revision, reoperation, implant removal, arthrodesis, mortality, procedure-confirmed complications)	Diagnosis codes, healthcare utilization (ED visits, readmissions, LOS), mortality, procedure-confirmed when available
Bilateral cases	Must be excluded	May be included with acknowledgment and sensitivity analyses
Laterality missingness	>20% rejected without review; 10-20% requires sensitivity analysis	>30% rejected without review for side-specific claims; 20-30% requires robust sensitivity analyses
PSM balance	SMD <0.1 required	SMD <0.1 required; 0.1-0.2 may be acceptable with sensitivity analysis; >0.2 rejected
Medication exposure	Generally unsuitable unless inpatient-administered with confirmed records	Acceptable as hypothesis-generating; limitations must be prominently discussed
Causal language	Must acknowledge unmeasured and case mix confounding	Must frame as associations or hypothesis-generating; no definitive treatment effects

Key Methodological Principles

The full instructions elaborate on each of these topics. Below is a brief orientation.

Clinical Grouping

Both journals require clinically homogeneous exposure groups. Combining distinct conditions or procedures (e.g., all ankle fractures together, or all GLP medications together) creates case mix confounding that cannot be corrected by statistical adjustment. Studies that group heterogeneous entities without justification and lack subgroup analysis will be rejected by either journal.

Laterality and Anatomic Specificity

CPT codes do not capture laterality. Authors must describe how procedure laterality was inferred from ICD-10-CM diagnosis codes, report the completeness of laterality coding, and acknowledge the limitations of this inference. FAI requires bilateral case exclusion and rejects studies with >20% laterality missingness. FAO permits bilateral cases with appropriate acknowledgment but rejects studies making side-specific claims with >30% missingness. Both journals require anatomic definitions specific to the region of interest; imprecise definitions spanning multiple anatomic regions will result in rejection.

Propensity Score Matching

Comparative studies must include comorbidity measures (e.g., Charlson or Elixhauser or equivalent list of comorbidities) for health-status-dependent outcomes; demographics-only matching is insufficient. Authors must report the matching algorithm, caliper, matching ratio, balance assessment (SMD), and unmatched patient characteristics. Both journals require SMD <0.1. FAO may accept SMD between 0.1 and 0.2 with sensitivity analyses; SMD >0.2 will result in rejection.

Medication and Substance Exposure

Prescription does not equal exposure. All medication/substance studies must acknowledge limitations of dose, adherence, temporal relationship, and duration. FAI considers these studies generally unsuitable (exception: inpatient-administered medications). FAO accepts them as hypothesis-generating, with a prominent discussion of limitations.

Reporting Standards

Both journals require STROBE and RECORD checklists, follow-up completeness reporting, complete code lists with justification for any grouping, explicit temporal windows for outcome ascertainment, and a patient flow diagram. The full instructions specify supplementary table and figure requirements.

Common Grounds for Rejection Without Review

Manuscripts submitted to either journal may be rejected without review if they:

1.     Address a study question that cannot be answered given the limitations of the database

2.     Lack complete code lists

3.     Group clinically distinct conditions or procedures without justification

4.     Fail to discuss the limitations of administrative data

5.     Examine medication/substance exposure without acknowledging adherence, dose, and temporal limitations

6.     Compare treatments without adequate confounding adjustment

7.     Use demographics-only matching for health-status-dependent outcomes

8.     Fail to report laterality missingness or follow-up completeness

9.     Lack explicit temporal windows for outcome ascertainment

10.  Use imprecise anatomic definitions spanning multiple regions

 

Journal-specific rejection criteria - including laterality thresholds, bilateral case rules, PSM balance thresholds, and outcome definitions - are detailed in the full instructions to authors.

Next Steps

Before writing your manuscript:

1.     Use the self-assessment checklists in the full instructions to Authors to confirm which journal fits your study.

2.     Review the complete requirements for your target journal, including laterality thresholds, bilateral case rules, PSM standards, and supplementary materials.

3.     Prepare your STROBE and RECORD checklists and complete code lists before submission.

The full instructions to authors are available here.

What We Do Not Publish

Bibliometric papers

Bibliometric methods are used to help estimate how much influence or impact a selected research article or individual researcher has had on the wider research community. It usually does this by counting the number of times an article is cited after it is published. These analyses can be used to track researcher output and impact related tenure, promotion and grant funding decisions. Their utility to the readership of Foot & Ankle Orthopaedics is minimal at best. For this reason FAI and FAO will not publish bibliometric papers.

Qualitative or mixed methods research

Although qualitative or mixed methods research can influence the direction of research or trial design, the AOFAS journals are generally focused on nearer term impact. Neither our peer reviewer pool nor our restrictions on word count are aligned with publishing qualitative or mixed methods research at FAI or FAO.

“Learning curve” Manuscripts

Orthopaedic “learning curve” papers deal with the attainment of proficiency in new surgical techniques or implants. The development of psychomotor surgical skills is a complex educational process, poorly measured by surgical time or predefined benchmark skills as indirect measures of proficiency. The generalizability of such data is also poor, inadequately reflecting care by all surgeons in various settings. Learning curve papers thus offer little to the readership of FAI and FAO and therefore will not be considered for publication.

Sports-Related Publicly Obtained Data Manuscripts

Neither FAI nor FAO will consider submissions that include sports-related injury, treatment, or recovery data obtained from PODs. Please refer to the editorial "Ensuring Scientific Rigor in Research: Why Sports-Related Publicly Obtained Data Fall Short," available here.

AOFAS Clinical Rating Systems – Do Not Use

We do not accept papers that rely primarily on the AOFAS Clinical Rating systems to assess patient outcomes from treatments. As stated in the 2011 AOFAS Position Statement Regarding the Future of the AOFAS Clinical Rating Systems and further emphasized in the 2014 AOFAS Position Statement Regarding Patient-Reported Outcome Measures, scores from the AOFAS Clinical Scoring Systems have not been found to be valid or reliable.

Pinsker E, Daniels TR. AOFAS Position Statement Regarding the Future of the AOFAS Clinical Rating Systems. Foot & Ankle International. 2011;32(9):841-842. doi:10.3113/FAI.2011.0841

Kitaoka HB, Meeker JE, Phisitkul P, Adams SB, Kaplan JR, Wagner E. AOFAS Position Statement Regarding Patient-Reported Outcome Measures. Foot & Ankle International. 2018;39(12):1389-1393. doi:10.1177/1071100718809066

Language to communicate specific regions and motions of the foot and ankle

Updated Document on Standard Terminology for Foot and Ankle

Submission Process Requirements:

1. Original Work: When you submit your work, you are confirming that it is your own original creation.
2. Rights and Permissions: You have the necessary rights to the work, and you can provide permissions for any copyrighted material that you don't own but have included in your work.
3. First Publication: Your work is being submitted to this journal for the first time, and it hasn't been published elsewhere or is currently under consideration for publication elsewhere. See Sage policy on prior publication.
4. Author Archiving Policy: If your article is accepted for publication, you can use and share your work as per the journal's policy on author archiving. This means you can share it in certain ways after it's been published.

Submission site

Submit your manuscript online via Sage Track.

IMPORTANT: Please check whether you already have an account in Sage Track before trying to create a new one. If you have reviewed or authored for the journal in the past year it is likely that you will have had an account created. For further guidance on submitting your manuscript online please visit ScholarOne Online Help.

Manuscripts should only be submitted with the consent of all contributing authors. The individual responsible for submitting the manuscript should carefully check that all those whose work contributed to the manuscript are listed as authors.

Ensure you upload all relevant manuscript files, including any additional supplemental files (including reporting guidelines where relevant).

Authorship

Please view our authorship policies, which includes information on criteria for authorship, who should be the corresponding author and more.

Please note that AI chatbots, for example ChatGPT, should not be listed as authors. For more information see the policy on Use of ChatGPT and generative AI tools.

Files

Uploading

Before submitting a manuscript, please gather the following information:

• Author information: first and last names, institutions, degrees, and active e-mail addresses.
• Manuscript title.
• Manuscript abstract, where applicable (Can be cut and pasted from your manuscript).
• Manuscript files in Word.
• Figures/Images in TIFF, JPG, or Postscript.
• FAI/FAO Disclosure Forms, one per author (Updated February 2026). 

• Complete list of authors, with their institutional affiliations.
• The author information you enter at submission must exactly match what is included on your manuscript and/or title page, including full names, academic affiliations, and corresponding author contact details.
• The listed affiliation should be the institution where the research was conducted. If an author has moved to a new institution since completing the research, the new affiliation can be included in a note at the end of the manuscript.
• All listed authors must meet the criteria for authorship (above).
• All persons eligible for authorship must be included at the time of submission.
• All authors must have given consent for the manuscript to be submitted in its current form.
• Keywords: During submission, you may be asked to select or enter keywords for your manuscript. These keywords are used to match appropriate reviewers to your manuscript.
• The number of figures, tables, and words in your manuscript.
• Funder information: Name, grant/award number.
• You may be required to enter your declaration of conflicting interest as part of the submission process, in addition to listing it on your manuscript and/or title page. Please have it on hand.

• If you have posted your manuscript to a preprint server, you will be asked to supply the DOI (this does not prohibit submission, but no changes should be made to the preprint version while your manuscript is under evaluation in this journal). Please see our guidelines on prior publication. If the article is accepted for publication, the author may re-use their work according to the journal's author archiving policy. If your manuscript is accepted, you must include a link in your preprint to the final version of your published article.

The following summary describes the peer review process for this journal:
Identity transparency: Double-anonymized
Reviewer interacts with: Editor
Review information published: None

Your manuscript will undergo an initial evaluation. If it does not conform to the requirements laid out in these guidelines, it will be returned to you for amendments prior to peer review. Manuscripts may be desk rejected without peer review at this point if they are out of scope for the journal or otherwise unsuitable.

After passing the initial evaluation, your manuscript will then be peer reviewed. You can log in at any time to check the status of your manuscript. We will notify you when a decision has been reached.

Manuscripts are evaluated by the FAO editorial staff and sent to outside reviewers for anonymized peer review. A decision on a manuscript that has been rejected is returned as quickly as possible. It usually takes more time to make a decision regarding a paper being considered for publication.

For a list of editorial board members, click here.

To ensure the integrity of the peer review process we assign reviewers and cannot accept author recommendations.

All manuscripts are reviewed as rapidly as possible, while maintaining rigor. Reviewers make comments to the author and recommendations to the Editor who then makes the final decision on all manuscripts, including those appearing in a special issue or special collection. The Editor or members of the Editorial Board may occasionally submit their own manuscripts for possible publication in the Journal. In these cases, the peer review process will be managed by alternative members of the Board and the submitting Editor/Board member will have no involvement in the decision-making process.

The journal has an Editorial Board, including Associate Editors, and peer reviewers who serve the journal as external peer reviewers. Each member of the Editorial Board are active researchers in the field and selected based on strict criteria, ensuring they possess the necessary expertise and experience. This ensures a comprehensive and robust peer review process, aligning with our commitment to publish the most credible and valid research. Care is taken not to invite any reviewer that has any potential conflict of interest with the paper. 

Read Sage's complete peer review policy.

Conflict of Interest

All authors submitting a manuscript to this peer-reviewed journal must disclose any conflicts of interest (COI) related to the submitted paper, using the FAI/FAO Disclosure Forms (Updated February 2026). A conflict of interest typically involves financial relationships (most commonly payments to surgeons or authors) that could reasonably be perceived as influencing the submitted work, whether received in the past or anticipated in the future. Authors should list any personal or family conflicts of interest related to the submitted manuscript or its subject matter (examples include consulting fees, honoraria, royalties, stock or stock options, research funding, paid advisory roles, product or material support, or intellectual property interests (e.g., potential future royalties) valued over $500, received within the past three years or expected in the future).

Disclosure of Off-Label Use

FDA/ Regulatory Agency Statement

Some drugs or medical devices discussed in articles may not have been approved by the FDA or appropriate regulatory agency for the author’s country for the specific purpose reported upon in the article. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or medical devices he or she wishes to use in clinical practice. The FAI / FAO Editorial Board has approved a policy that “off label” uses of a drug or medical device may be reported so long as the “off label” use of the drug or medical device is specifically disclosed (ie, it must be disclosed that the FDA or the appropriate regulatory agency for the author’s country has not cleared the drug or device for the described purpose). Any drug or medical device has been used “off label” if the described use was not set forth on the product’s approval label.

Plagiarism and Duplicate Submission

Plagiarism simply defined is using previously published work without properly citing the original publication in the text of a paper. It is unethical, infringes upon copyrighted material and the manner in which to deal with it has been discussed extensively by organizations such as the Committee on Publication Ethics (COPE). Submitted papers are screened with plagiarism software, iThenticate. This software identifies passages in a paper that are identical to previously published papers.

If a paper is found to have significant duplication with previous publications, it will be rejected before review and all of the authors of the paper will receive a letter giving the reason for rejection along with the iThenticate report for the paper in question. Authors may appeal if they feel the decision was unjustified or they may revise the text to eliminate the duplicated text and re-submit to the journal, at which time the article will again be analyzed through iThenticate.

Duplicate submission refers to act of submitting a manuscript to more than one journal at the same time. Duplicate publication refers to the practice of publishing the same article in two or more different journals. Upon submitting an article to Foot & Ankle Orthopaedics, all corresponding authors must acknowledge by checking a box "Confirm that the manuscript has been submitted solely to this journal and is not published, in press, or submitted elsewhere." The Editorial Board has established a policy on duplicate submission or publication that authors who are found to have a duplicate submission or publication will be barred from submitting any papers for 1 year from the time of discovery of the duplicate submission or publication.

Plagiarism

The journal and Sage take issues of copyright infringement, plagiarism or other breaches of best practice in publication very seriously. Please read Sage's complete policy on plagiarism and the actions we may take.

After acceptance you will receive instructions via email inviting you to complete the Open Access process. This will include signing the appropriate Creative Commons license and, where applicable, paying the Article Processing Charge (APC) or assigning a bill payer. Once the APC has been processed, your article will be prepared for publication and can appear online within an average of 30 days. Please note that, where an APC is applicable, production work cannot be completed on your manuscript until payment has been received.

Contributor’s Publishing Agreement

Before publication we require the author as the rights holder to sign a Journal Contributor’s Publishing Agreement. The journal publishes manuscripts under Creative Commons licenses. The standard license for the journal is Creative Commons by Attribution Non-Commercial (CC BY-NC), which allows others to re-use the work without permission as long as the work is properly referenced and the use is non-commercial. For more information, you are advised to visit Sage's OA licenses page. Alternative license arrangements are available at the author’s request (e.g. to meet particular funder mandates).

Preprints

If your manuscript was posted on a preprint server prior to acceptance, you must include a link in your preprint to the final published version of your published article.

Production

Your Sage Production Editor will keep you informed as to your article’s progress throughout the production process. Proofs will be made available to the corresponding author via our editing portal, Sage Edit, or by email, and should be returned promptly to avoid delaying publication. Authors are reminded to check their proofs carefully to confirm that all author information, including names, affiliations, sequence, and contact details are correct, and that Funding and Conflict of Interest statements, if any, are accurate. This is the final opportunity to make changes to your manuscript. Further corrections will not be possible after publication. Changes to the author list are not permitted at this stage.

Publication

One of the many benefits of publishing your research in an open access journal is the speed to publication. With no page count constraints, your article will be published online in a fully citable form with a DOI number as soon as it has completed the production process. At this time it will be completely free to view and download for all.

Promoting your article

Publication is not the end of the process. Between us, we can ensure that your article is found, read, downloaded and cited as widely as possible. Many of the most effective tactics are those you can do quickly and easily to your network of contacts and peers. Visit the Promote Your Article page on the Sage Journal Author Gateway for numerous resources to help you promote your work.

The Sage Journal Author Gateway has some general advice on how to get published, plus links to further resources. Sage Author Services also offers authors a variety of ways to improve and enhance your article including English language editing, plagiarism detection, and video abstract and infographic preparation.

If you have any questions about publishing with Sage, please visit the Sage Journals Solutions Portal.

You can view our complaints and appeals procedure.

Contact us

You can direct any questions to the journal’s editorial office:

FAOjournal@aofas.org

Appealing the Publication Decision

Authors may appeal decisions by contacting the Editor-in-Chief. Authors should recognize that a high burden of proof exists to overturning a negative peer-review decision. All appeals are reviewed by the Editor-in-Chief or his/her designated associate editor.

If an author believes the decision regarding their manuscript was affected by a publication ethics breach, the author may contact the publisher through the Sage complaints and appeals procedure.