Impact of Social Deprivation on Forefoot Surgical Outcomes

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The impact of social environment on specific health outcomes is a topic of increasing interest in orthopedics. Conflicting lines of research suggest that social deprivation may impact orthopedic outcomes. There are limited reports on the influence of social deprivation on orthopedic foot and ankle procedures. The purpose of this study was to examine the effect of social deprivation on patient reported outcomes for patients undergoing forefoot surgery. Methods: This retrospective cohort study included 477 patients who underwent hallux valgus correction or hallux rigidus procedures between 2015 and 2022. Patient social deprivation was defined using the Area Deprivation Index (ADI), a validated metric of deprivation discretized geographically by zip code and defined by factors including education, income, employment, and housing quality. Patients meeting inclusion criteria were categorized into either a high or low social deprivation group based on the national median ADI of 50. PROMIS (Patient-Reported Outcomes Measurement Information System) Physical Function (PF) and Pain Interference (PI) scores were collected pre-operatively and then at 6 weeks and 6 months post-operatively. We compared high and low social deprivation groups at baseline and then longitudinally at 6 weeks and 6 months post-operatively, adjusting for demographic covariates including age, gender, race/ethnicity, marital status, and employment status. Statistical significance was defined as p < 0.05. Results: At baseline before surgery, PROMIS-PF and PROMIS-PI scores were similar between high and low social deprivation groups. At 6 weeks and 6 months after surgery, there were also no significant differences between high and low deprivation groups for either PROMIS-PF or PROMIS-PI. The only variable that delineated outcomes was employment status, with disabled and unemployed patients exhibiting greater pain (p < 0.001, p = 0.006, respectively) and less function (p < 0.001, p = 0.010, respectively) before surgery. When adjusting for baseline pain score, disabled patients also had greater pain on average after surgery (p = 0.031). Both groups (high and low social deprivation) demonstrated similar improvements in pain and function at 6 months after surgery. Conclusion: Patients undergoing forefoot surgery with greater social deprivation reported similar pain and physical function outcomes as patients with low deprivation before and after surgery. These findings suggest that patients with higher social deprivation can achieve equivalent post-surgical outcomes after forefoot surgery as compared to patients with lower social deprivation. Further investigations are needed to explore these relationships at longer-term follow-up as well with other common foot and ankle surgeries.