Musculoskeletal conditions of the foot and ankle are widespread, yet the cost‐effectiveness of the variety of treatments available is not well defined. Therefore, this systematic review aimed to identify, appraise, and synthesize the literature about the cost‐effectiveness of interventions for musculoskeletal foot and ankle conditions.

Electronic databases were searched for studies presenting economic evaluations of non‐surgical and surgical treatments for acute or chronic musculoskeletal conditions of the foot and ankle. Data on cost, incremental cost‐effectiveness, and quality‐adjusted life-years for each intervention and comparison were extracted. Thirty‐six studies were identified reporting non‐surgical interventions (n=10), non‐surgical versus surgical interventions (n=14) and surgical interventions (n=12). The strongest economic evaluations were for interventions managing end‐stage ankle osteoarthritis, calcaneal fracture, Achilles tendon rupture, ankle sprain, and ankle fracture. Total ankle replacement and ankle arthrodesis for end‐stage ankle osteoarthritis, in particular, has been demonstrated through high‐quality studies to be cost‐effective compared to the non‐surgical alternative.

In conclusion, the selected interventions for musculoskeletal foot and ankle conditions dominate comparators, whereas others require thoughtful consideration as they provide clinical improvements but at an increased cost. Researchers should consider measuring and reporting costs alongside clinical outcomes to provide context when determining the appropriateness of interventions for other foot and ankle complaints to inform future clinical practice guidelines best.