Smartphone applications and its role in foot and ankle surgery (Preprint)
Authors: Nagaraj Prashanth , Dilaver 2nd Nafi Mehmet , Patil Amogh , Akhter Maaz , Bhambani Lokesh , Tross Samantha , Saavedra Enrique , Baghla Davinder Paulsingh 
Published: July 2020

BACKGROUND

The coronavirus disease 19 (COVID-19) pandemic has exposed inherent weaknesses in global healthcare systems. Conversely, it has encouraged innovation, research and collaboration. Digital technology and AI has the ability to tackle these difficulties via the use of applications. However, the reliability and validity of unregulated medical applications must be questioned. The aim of this study was to review surgical foot and ankle themed applications and specifically assess the level of involvement from medical professionals in the design and content.The orthopaedic apps currently available have a variety of uses – they can be related to patient education, physician education, clinical evaluation, clinical treatment and surgical training. As of April 2020 there were 2.56 million apps available to download on Google Play, making it the largest app store on the market . Apple's app Store is the second-largest with approximately 1.85 million Apps available for iOS . Smartphone Apps provide platform for surgeons and software developers to collaborate and create novel tools to assist surgeons in practice and education. The purpose of this review is to identify and assess all smartphone apps related to the field of foot and ankle surgery.

OBJECTIVE

To summarize the most popular and useful foot and ankle apps.
To provide an overview about app usage, customer satisfaction and availability.
To provide recommendations to the foot and ankle community regarding medical profession involvement in the development of these apps.

METHODS

A team of reviewers searched the The App Store (iOS), Google Play (Android) and the BlackBerry App World (Blackberry) for foot and ankle themed applications. Due to Official shut down of blackberry World on 31st December 2019 and most of Blackberry devices since 2015 no longer used Blackberry 10operating system but used Android reviews were restricted to Android and iOS stores. The following search terms were used: bunions, ankle sprains, diabetic foot, foot and ankle deformities, pre-op templating, Patho-anatomy, post-operative rehab, gait, measurement of clinical angles of foot and ankle. A qualitative analysis of the data collected was performed. Data collected included target audience of the apps, patient and healthcare worker involvement and customer satisfaction reviews. The total number of applications and their availability in the UK were also noted

RESULTS

35 individual foot and ankle themed applications were identified. 30 applications had customer satisfaction ratings, 11 applications were predominantly health-worker centric and 3 were patient centered. 23 applications had medical professional involvement in their development or content.

CONCLUSIONS

Lack of involvement of medical professionals and scientific validation is of major concern hence there should be Industry code of conduct for a balance for ensuring patient safety while supporting innovation in development.
The benefits of applications are offset by the lack of Foot and ankle specification. There is relatively little medical professional involvement in their design. Increased regulation is required to improve accountability of application content