Patient reported anxiety and depression following hallux valgus surgery: a comparative cohort study of two year clinical outcomes

T. Lewis, R. Ray, D.J Gordon

Introduction: The role and impact of pre-operative mental health, anxiety and depression on the clinical outcome of hallux valgus surgery is poorly understood with limited literature available despite the high prevalence of anxiety, depression and musculoskeletal pathology in the general population.

Methods: A prospective comparative observational study of consecutive patients who underwent third-generation minimally invasive hallux valgus deformity correction. Patients who reported anxiety or depression on a pre-operative EQ-5D-5L questionnaire were allocated to the anxiety/depression cohort (A/D) whilst patients who reported no anxiety or depressive symptoms were allocated to a control cohort. The primary outcome measure was the Manchester Oxford Foot Questionnaire (MOXFQ). Secondary outcome measures were the EQ-5D-5L, Visual Analogue Scale for Pain (VAS-Pain), and radiographic deformity correction. Patients were followed up for a minimum of two years.

Results: Between July 2014 and July 2019, 265 feet (n=182 patients) underwent hallux valgus corrective surgery with 40 of these feet allocated to the A/D cohort. Patients in the A/D cohort had significantly worse pre-operative quality of life and MOXFQ scores compared to the control cohort. Both cohorts reported a statistically significant improvement in all MOXFQ domains two years following surgery (p<0.001). There was no difference between the two cohorts for any of the MOXFQ domains  at 2 years followup. 80% of patients in the A/D cohort reported an improvement in their anxiety/depression symptoms following surgery. There was no difference between the cohorts for radiographic deformity correction or VAS-Pain. Patients with anxiety/depression had a worse quality of life compared to the control group at two years following surgery.

Conclusion: This study has demonstrated that two years following surgery, patients with anxiety and/or depression symptoms have no difference in foot-related clinical outcomes compared to those without anxiety and/or depression symptoms despite having significantly worse symptoms pre-operatively.