About

Lorraine Boakye, MD, is an Assistant Professor of Orthopaedic Surgery at the Hospital of the University of Pennsylvania. She serves as the Director of Clinical Research in the Foot and Ankle Division within the Department of Orthopaedic Surgery. Her clinical expertise focuses on foot and ankle injuries, and her research interests include Achilles rupture and tendinopathy, patient-reported outcome measures, sociodemographic factors affecting foot and ankle conditions, and sustainability in surgery. Dr. Boakye has contributed to numerous publications in her field, advancing understanding of Achilles tendon repair, gait analysis during immobilization, and the impact of sociodemographic factors on foot and ankle health.

Research topics

• Medicine
• Surgery
• Physical therapy
• Computer science
• Environmental science

Selected publications

• Achilles Tendon Surgical Repair Partially Restores Early Plantar Flexor Structure and Function in a Rat Model

  Journal of Orthopaedic Research® · 2025-01-06 · 1 citations

  articleOpen access

  Achilles tendon ruptures significantly impair long-term patient function, with two-thirds of patients experiencing persistent functional deficits. Although nonsurgical treatment has gained popularity due to its perceived lower risk of complications, the specific effects of this approach on tendon healing, muscle function, and overall performance remain poorly understood. Directly comparing surgical and nonsurgical treatment options in a clinical population is challenging given the diverse nature of the patient population. Preclinical models are essential to isolate the mechanisms underlying these treatments, enabling a detailed examination of the structural and functional outcomes that are difficult to assess in human studies. Here, we surgically induced Achilles tendon ruptures in 20 adult male Sprague Dawley rats and repaired the rupture in half of these animals. Then, functional outcomes were assessed by measuring plantar flexor torque across the ankle's range of motion using a custom-developed small animal dynamometer, and structural changes were evaluated through measurements of Achilles tendon elongation and plantar flexor muscle mass. We found that surgical treatment led to 11%-35% increased functional plantar flexor torque outcomes compared to nonsurgical treatment. Additionally, plantar flexor muscle mass decreased by 21% in nonsurgically treated animals compared to only 12% in the surgically treated group. Our results suggest that surgically repairing a tendon rupture restores plantar flexor function more effectively than nonsurgical treatment; however, persistent functional deficits in both groups indicate that enhanced rehabilitation strategies are necessary for full functional restoration.

  PublisherOA PDFDOI

• Comparison of Patient-Reported Outcomes for Molded Ankle-Foot Orthosis vs Traditional Walking Boot for Achilles Tendinopathy: A Retrospective Study

  Foot & Ankle Orthopaedics · 2025-10-01

  articleOpen accessSenior author

  Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Treatment of Achilles tendinopathy remains a therapeutic challenge for orthopaedic surgeons due to lack of consensus regarding optimal patient-centered treatment protocol. Available treatment options include physical therapy, analgesics, immobilization, and surgery. However, not every patient is an optimal candidate for surgery, thus making the need for a sustainable and effective alternative necessary. Common non-operative management includes immobilization via tall CAM walker boot (walking boot) and less commonly, use of custom molded ankle-foot orthoses (mAFO). However, little objective evidence exists to evaluate the efficacy of the mAFO compared to the walking boot. This study aims to identify the level of patient satisfaction and treatment efficacy in using the mAFO and the walking boot for Achilles tendinopathy. Methods: Patients with Achilles tendinopathy were identified in this retrospective study by ICD-10 codes and prescription for a mAFO or walking boot by an Orthopaedic foot and ankle provider between 2016 and 2024. Patients were excluded if they had prior Achilles rupture or subsequent surgery, neurological foot/ankle disorders, and ankle injury or corticosteroid injection within 3 months of enrollment. After collection of patient contact information, surveys regarding satisfaction, functionality, and treatment course were sent to patients prescribed a mAFO or a walking boot for Achilles tendinopathy. The initial round of surveys was sent as a link to patients via email and text message. Non-responders were sent a reminder text each day for the following three days, which was then repeated two weeks later if no response was received. Patients were declared official non-respondents after receiving and not responding to a phone call from team members after the first two attempts. Results: Seventy-nine of 305 mAFO patients (26%) and 27 of 78 walking boot patients (35%) completed the survey. Fifty (63%) mAFO and 16 (59%) walking boot patients reported treatment interventions prior to immobilization. Fifty-three (67%) mAFO and 24 (89%) walking boot patients were “satisfied” with their treatment. Twenty-five (32%) mAFO and 13 (48%) walking boot patients underwent additional treatment after completion of the immobilization course. The mean Achilles tendon function rating score was 72 in the mAFO group and 75 in the walking boot group on a scale of 1 (nonfunctional) to 100 (completely functional), with the TOST procedure confirming equivalence within an equivalence margin of 1 (lower t = 0.2944, upper t = 0.6395, t-critical = 1.660, df = 101, α = 0.05). Conclusion: Both the mAFO and the walking boot are acceptable non-operative treatment options for Achilles tendinopathy as both demonstrate a high level of patient satisfaction, restoration of acceptable functional status, and reduction in the need of additional treatment after completing their prescribed immobilization course. The TOST procedure demonstrated that Achilles function scores in both the mAFO and walking boot groups are equivalent, indicating that both treatment options are viable non-operative alternatives to surgical intervention. These non-surgical options can be valuable for patients with Achilles tendinopathy who either prefer to defer surgery or are not suitable surgical candidates.

  PublisherDOI

• The Difference in Achilles Tendon Loading within Immobilizing Boots Based on Ankle Angle, Boot Type, and Walking Speed

  Orthopaedic Journal of Sports Medicine · 2024-10-01 · 5 citations

  articleOpen access

  Background: Achilles tendon rupture is an increasingly common injury treated with progressive rehabilitation in an immobilizing boot. However, it is poorly understood how ankle angle, boot type, and walking speed affect Achilles tendon loading. Hypothesis: These different parameters would affect Achilles tendon loading in terms of (from greatest to least) ankle angle constraint, immobilization style, boot construction, and walking speed. Study Design: Descriptive laboratory study. Methods: ) walked in 3 different immobilizing boots at self-selected slow, medium, and fast walking speeds. The authors estimated Achilles tendon loading using a 3-part instrumented insole within the immobilizing boot. The authors averaged tendon load across every stride for each condition and calculated 2-sided bootstrap confidence intervals. Peak tendon loading was compared across all boots, ankle angles, and walking speeds. Results: All boots and immobilization styles decreased tendon loading with respect to shod walking. Immobilization angle had the largest effect on tendon loading, followed by boot construction, and finally walking speed. Conclusion: Ankle angle, boot type, and walking speed can be modified to change loading progression during rehabilitation. Clinical Relevance: Understanding how immobilization affects tendon loading will enable clinicians to modify rehabilitation to improve functional outcomes.

  PublisherDOI

• Achilles Rupture in the Setting Posterior Tibial Osteochondroma: A Case Report and Guidelines for Management of Osteochondromas Adjacent to Tendons

  Journal of Orthopaedic Case Reports · 2023-01-01

  articleOpen access1st authorCorresponding

  Introduction: The presentation of the included patient is unique, and the thought process regarding management algorithms used to manage this patient is important to discuss so that other surgeons may benefit. This is the first report of its kind, to our knowledge. Case Report: A 30-year-old healthy Caucasian male presented with acute Achilles tendon rupture after feeling a pop while playing basketball, in the setting of a known posterior tibial osteochondroma and a recent increase in physical activity. Conclusion: The resultant injury is likely due to mechanical irritation at the tendon site, which caused wear over time and eventual acute rupture. We expanded our percutaneous repair to include an evaluation of the posterior compartment to adequately visualize and excise the large bony lesion. Therefore, we conclude that it is reasonable to counsel patients with known osteochondromas in this location due to the risk of possible Achilles injury, particularly if at all symptomatic.

  PublisherDOI

• Wearable sensor and machine learning accurately estimate tendon load and walking speed during immobilizing boot ambulation

  medRxiv · 2023-06-05 · 1 citations

  preprintOpen access

  Achilles tendon injuries are treated with progressive weight bearing to promote tendon healing and restore function. Patient rehabilitation progression are typically studied in controlled, lab settings and do not represent the long-term loading experienced during daily living. The purpose of this study is to develop a wearable paradigm to accurately monitor Achilles tendon loading and walking speed using low-cost sensors that reduce subject burden. Ten healthy adults walked in an immobilizing boot under various heel wedge conditions (30°, 5°, 0°) and walking speeds. Three-dimensional motion capture, ground reaction force, and 6-axis inertial measurement unit (IMU) signals were collected per trial. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to predict peak Achilles tendon load and walking speed. The effects of using only accelerometer data, different sampling frequency, and multiple sensors to train the model were also explored. Walking speed models outperformed (mean absolute percentage error (MAPE): 8.41 ± 4.08%) tendon load models (MAPE: 33.93 ± 23.9%). Models trained with subject-specific data performed significantly better than generalized models. For example, our personalized model that was trained with only subject-specific data predicted tendon load with a 11.5 ± 4.41% MAPE and walking speed with a 4.50 ± 0.91% MAPE. Removing gyroscope channels, decreasing sampling frequency, and using combinations of sensors had inconsequential effects on models performance (changes in MAPE < 6.09%). We developed a simple monitoring paradigm that uses LASSO regression and wearable sensors to accurately predict Achilles tendon loading and walking speed while ambulating in an immobilizing boot. This paradigm provides a clinically implementable strategy to longitudinally monitor patient loading and activity while recovering from Achilles tendon injuries.

  PublisherOA PDFDOI

• Scope of the Problem: Tendoscopy and Small Joint Arthroscopy of the Foot and Ankle.

  PubMed · 2023-01-01 · 1 citations

  article1st authorCorresponding

  It is important to identify and describe practical applications of arthroscopy in the management of foot and ankle pathology. Utilization of the arthroscope provides a minimally invasive means of evaluating and addressing pathology. It obviates the need for a large open approach, which has additional value in the setting of a multiprocedure surgery. In addition to reducing surgical time, arthroscopy provides a potentially enhanced field of view and an adequate working space to address injury. As interest in minimally invasive options grows, the need for safe, effective tendoscopic and arthroscopic options in the foot and ankle increases. A clear and high-yield reference is needed with which to approach these procedures.

  Publisher

• The Effects of Sociodemographic Factors on Baseline Patient-Reported Outcome Measures in Patients with Foot and Ankle Conditions

  Journal of Bone and Joint Surgery · 2023-03-30 · 5 citations

  article1st authorCorresponding

  BACKGROUND: Racial and ethnic care disparities persist within orthopaedics in the United States. This study aimed to deepen our understanding of which sociodemographic factors most impact patient-reported outcome measure (PROM) score variation and may explain racial and ethnic disparities in PROM scores. METHODS: We retrospectively reviewed baseline PROMIS (Patient-Reported Outcomes Measurement Information System) Global-Physical (PGP) and PROMIS Global-Mental (PGM) scores of 23,171 foot and ankle patients who completed the instrument from 2016 to 2021. A series of regression models was used to evaluate scores by race and ethnicity after adjusting in a stepwise fashion for household income, education level, primary language, Charlson Comorbidity Index (CCI), sex, and age. Full models were utilized to compare independent effects of predictors. RESULTS: For the PGP and PGM, adjusting for income, education level, and CCI reduced racial disparity by 61% and 54%, respectively, and adjusting for education level, language, and income reduced ethnic disparity by 67% and 65%, respectively. Full models revealed that an education level of high school or less and a severe CCI had the largest negative effects on scores. CONCLUSIONS: Education level, primary language, income, and CCI explained the majority (but not all) of the racial and ethnic disparities in our cohort. Among the explored factors, education level and CCI were predominant drivers of PROM score variation. LEVEL OF EVIDENCE: Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

  PublisherDOI

• Wearable sensor and machine learning estimate tendon load and walking speed during immobilizing boot ambulation

  Scientific Reports · 2023-10-23 · 11 citations

  articleOpen access

  The purpose of this study is to develop a wearable paradigm to accurately monitor Achilles tendon loading and walking speed using wearable sensors that reduce subject burden. Ten healthy adults walked in an immobilizing boot under various heel wedge conditions (30°, 5°, 0°) and walking speeds. Three-dimensional motion capture, ground reaction force, and 6-axis inertial measurement unit (IMU) signals were collected. We used a Least Absolute Shrinkage and Selection Operator (LASSO) regression to predict peak Achilles tendon load and walking speed. The effects of altering sensor parameters were also explored. Walking speed models (mean absolute percentage error (MAPE): 8.81 ± 4.29%) outperformed tendon load models (MAPE: 34.93 ± 26.3%). Models trained with subject-specific data performed better than models trained without subject-specific data. Removing the gyroscope, decreasing the sampling frequency, and using combinations of sensors did not change the usability of the models, having inconsequential effects on model performance. We developed a simple monitoring paradigm that uses LASSO regression and wearable sensors to accurately predict (MAPE ≤ 12.6%) Achilles tendon loading and walking speed while ambulating in an immobilizing boot. This paradigm provides a clinically implementable strategy to longitudinally monitor patient loading and activity while recovering from Achilles tendon injuries.

  PublisherOA PDFDOI

• Patient-Reported Outcome Measures After Surgical Management of Unstable Lisfranc Injuries in Athletes

  Foot & Ankle Orthopaedics · 2023-01-01 · 1 citations

  articleOpen access

  Background: Athletes sustaining Lisfranc joint instability after a low-energy injury often undergo surgical fixation. Limited studies report validated patient-reported outcome measures (PROMs) for this specific patient population. Our purpose was to report PROMs of athletes experiencing instability after a low-energy Lisfranc injury and undergoing surgical fixation. Methods: Twenty-nine athletes (23 competitive, 6 recreational) sustained an unstable Lisfranc injury (14 acute, 15 chronic) and met our inclusion criteria. Injuries were classified as acute if surgically managed within 6 weeks. All athletes completed validated PROMs pre- and postoperatively. The cohort underwent various open reduction internal fixation methods. We evaluated outcomes with the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales. Results: = .002) subscales were found, when comparing preoperative to postoperative scores at ≥2 years. Conclusion: This study provides outcomes information for the young athletic population that were treated operatively for low-energy Lisfranc injury with apparent joint instability. Based on the FAAM sports subscale, these patients on average improved between their 6-month evaluation and their final ≥2 years but still scored 80% of the possible 100%, which indicates continued but "slight" difficulty with lower extremity function. Level of Evidence: Level IV, case series.

  PublisherDOI

• Assessment of Outcome Scores of the Ankle

  2023-01-01

  book-chapter
  PublisherDOI

Frequent coauthors

• Umile Giuseppe Longo

  Campus Bio Medico University Hospital

  253 shared

• Yoshiharu Shimozono

  Kyoto University

  135 shared

• Kenneth J. Hunt

  132 shared

• Gian Luigi Canata

  Ospedale Koelliker

  132 shared

• Gino M. M. J. Kerkhoffs

  University of Amsterdam

  129 shared

• Jari Dahmen

  128 shared

• Cortez L. Brown

  University of Pittsburgh

  126 shared

• Stephen P. Canton

  University of Pittsburgh Medical Center

  124 shared

Labs

• Orthopaedic Surgery at the University of PennsylvaniaPI