Foot & Ankle International - July 2018 - 795

762137
research-article2018

FAIXXX10.1177/1071100718762137Foot & Ankle InternationalShakked et al

Article

Influence of Depressive Symptoms
on Hallux Valgus Surgical Outcomes

Foot & Ankle International®
2018, Vol. 39(7) 795-800
© The Author(s) 2018
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https://doi.org/10.1177/1071100718762137
DOI: 10.1177/1071100718762137
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Rachel Shakked, MD1, Elizabeth McDonald, BA1 ,
Ryan Sutton, BS2, Mary-Katherine Lynch, BS1,
Kristen Nicholson, PhD1, and Steven M. Raikin, MD1

Abstract
Background: The relationship between depressive symptoms and patient outcomes after hallux valgus surgery has not
been well-studied. We hypothesized that patients with depressive symptoms would have greater subjective dysfunction
preoperatively and less functional improvement and satisfaction after surgery when compared with patients without
depressive symptoms.
Methods: A total of 239 adult patients who had surgical hallux valgus correction over a 2-year period were retrospectively
enrolled. A telephone survey was administered prospectively at least 11 months postoperatively inquiring about overall
satisfaction level with surgery and satisfaction with postoperative pain level. A scale of 0 to 6 was used, with 0 indicating
complete dissatisfaction and 6 indicating complete satisfaction. Patients were divided into 2 groups based on depressive
symptoms; a Short Form-12 mental component score (SF-12 MCS) of less than 45.6 points was considered indicative
of active depressive symptoms based on literature correlating SF-12 scores with Patient Health Questionnaire-9 for
depression. Given the great variability of depressive symptoms in patients with or without self-reported depression and
medicated or unmedicated status, we elected to use the MCS classification of depressive symptoms for our analysis. Data
from 239 patients were available for analysis, with an average age of 51.6 years and 207 women (87%). Two hundred
eighteen patients (91%) completed preoperative functional scores, 160 patients (67%) completed the satisfaction survey
at an average of 23 months postoperatively (range 11 to 43 months), and 154 patients (64%) completed postoperative
functional scores an average of 21 months postoperatively (range, 11-44 months).
Results: Thirty-six of 239 patients (15%) with baseline functional scores exhibited depressive symptoms. There was no
significant difference in baseline functional scores and pain levels between groups with the exception of the SF-12 MCS (P
< .001). Most outcomes improved significantly over time, including the SF-12 physical component score (P = .013), Foot
and Ankle Ability Measure (FAAM; P = .013), and FAAM Activities of Daily Living (P = .046). The patients with depressive
symptoms generally had lower scores at baseline and final follow-up in all functional scores, with the exception of visual
analog scale (VAS). VAS pain scores started higher in the group of patients with depressive symptoms and ended lower.
Satisfaction with postoperative pain was lower in the group with depressive symptoms when compared with patients
without depressive symptoms (3.6 vs 4.5, P = .042). There was no significant difference in satisfaction after surgery between
groups (P = .251).
Conclusion: Patients with depressive symptoms had greater pain at baseline and less pain postoperatively when compared
with patients without depressive symptoms; however, satisfaction levels with postoperative pain were lower in these
patients. Furthermore, most functional scores were lower in patients with depressive symptoms, with the exception of
the MCS. Reported history of depression was not associated with any significant difference in functional outcome scores
or satisfaction. Further study is warranted to determine why patients with depressive symptoms fare worse after surgical
hallux valgus correction by most subjective measures.
Level of Evidence: Level III, comparative study.
Keywords: hallux valgus, surgery, outcome, depression

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