Evaluation of Psychological Factors Influencing Treatment Outcomes in Chronic Foot and Ankle Diseases

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: While the impact of psychological factors on surgical outcomes has been extensively studied in spinal surgery and total hip and knee arthroplasty, reports in the field of foot and ankle surgery remain scarce. This study investigates the influence of psychological factors on clinical outcomes in patients undergoing surgery for chronic foot diseases. Methods: This study included 24 patients (25 feet; 3 males, 21 females) who underwent surgical treatment for hallux valgus (HV, 15 feet) or osteoarthritis of the ankle (OA, 10 feet) between October 2020 and May 2022, with a minimum follow-up of one year. Psychological factors were assessed preoperatively using the Hospital Anxiety and Depression Scale (HADS), Central Sensitization Inventory (CSI), Tampa Scale for Kinesiophobia (TSK), and Pain Catastrophizing Scale (PCS). Clinical outcomes were evaluated using the Japanese Society for Surgery of the Foot (JSSF) scale, measuring hallux function for HV and ankle/hindfoot function for OA, both preoperatively and postoperatively. A multivariate regression analysis was performed, adjusting for disease type (HV or OA), to examine the association between preoperative psychological scores and the degree of improvement in the JSSF scale. The significance level was set at p < 0.05. Results: The mean age at surgery was 61.8 years. Surgical procedures for HV included 11 cases of modified Lapidus procedures and 4 cases of Akin or Mitchell osteotomies. Procedures for OA included 8 cases of ankle arthrodesis, 1 case of distal tibial oblique osteotomy, and 1 case of total ankle replacement. A higher preoperative HADS-Anxiety score was significantly associated with lower postoperative improvement in the pain subscale of the JSSF scale (β = - 0.33, p = 0.048). No significant associations were found between psychological assessments and the improvement in the function or alignment subscales of the JSSF scale. Additionally, there was no significant correlation between psychological factors and the total JSSF score improvement. Conclusion: Previous studies on total hip arthroplasty have reported that patients with anxiety traits tend to exhibit lower postoperative pain scores. Our findings are consistent with these reports. Psychological factors appear to influence pain improvement more than functional recovery, with no apparent impact on alignment, a trend also observed in our study. Furthermore, psychological factors did not affect the total JSSF score. Future studies with larger sample sizes are warranted to further investigate these associations.