Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1409-20. doi: 10.1007/s00167-015-3976-y. Epub 2016 Mar 18.


Purpose: To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.

Methods: Following a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.

Results: 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6% (95% CI 0.4-0.8%) and 1% (95% CI 0.2-1.7%), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5% (95% CI 6.8-18.2%) and 10.5% (95% CI 5.0-15.9%), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7% (95% CI 5.5-8.5%) and radiological incidence of 35.3% (95% CI 26.4-44.3%).

Conclusion: Isolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.

Level of evidence: II.

Keywords: Achilles tendon; Deep vein thrombosis; Foot and ankle surgery; Low molecular weight heparin; Lower limb surgery; Venous thromboembolism.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Achilles Tendon / injuries
  • Ankle / surgery*
  • Chemoprevention
  • Foot / surgery*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Postoperative Complications / prevention & control*
  • Venous Thromboembolism / prevention & control*


  • Heparin, Low-Molecular-Weight