Preoperative Mental Health,Sociodemographic,and Clinical Correlates of Baseline Pain and Function in Hallux Valgus Surgery Candidates

Abstract

Background:

Pain and dysfunction are common indications for hallux valgus surgery, yet the factors that are associated with these baseline symptoms are not fully understood. This study aimed to investigate the associations of patient and disease specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing hallux valgus surgery.

Methods:

A prospective cohort of 221 hallux valgus surgeries were enrolled (January 2021 to November 2023). A total of 181 (82%) patients who had undergone surgery met inclusion criteria. Patients completed PROMs preoperatively assessing mental health (VR-12 Mental Component Summary [MCS]), pain (visual analog scale [VAS]), and function (Foot and Ankle Ability Measure–Activities of Daily Living [FAAM-ADL] and FAAM Single Assessment Numeric Evaluation [FAAM-SANE]).

Results:

Better mental health was associated with higher preoperative function and lower pain: each 1-point higher VR-12 MCS corresponded to +0.62 FAAM-ADL points (95% CI 0.27-0.98; P = .001), +0.52 FAAM-SANE points (0.11-0.93; P = .013), and −0.06 VAS points (−0.09 to −0.02; P = .004). Education showed similar associations: per additional year, +1.85 FAAM-ADL (0.68-3.03; P = .002), +1.74 FAAM-SANE (0.39-3.09; P = .012), and −0.16 VAS (−0.28 to −0.03; P = .013). Male sex was linked to better function on FAAM-SANE (+13.64; 1.93-25.34; P = .023) and lower pain (−1.14 VAS; −2.22 to −0.06; P = .038); the FAAM-ADL difference was not significant (P = .513). Higher BMI was associated with worse FAAM-SANE function (−0.89; −1.56 to −0.22; P = .010) but not FAAM-ADL (P = .510) or VAS pain (P = .916). Greater socioeconomic deprivation (Area Deprivation Index [ADI]) was associated with higher pain (+0.02 VAS per ADI point; 0.00-0.04; P = .041). Diabetes and prior surgery were associated with lower VAS pain in the adjusted table (diabetes: −1.87; −3.66 to −0.08; P = .041; prior surgery: −2.37; −4.29 to −0.44; P = .017), which differs from the narrative; this should be reconciled. Other covariates were not significantly associated with outcomes.

Conclusion:

Better preoperative mental health and higher education were associated with higher function and lower pain; male sex with higher function (FAAM-SANE) and lower pain; higher BMI with worse FAAM-SANE only; greater deprivation with higher pain; diabetes and prior surgery with slightly lower pain; other covariates showed no consistent associations.

Level of Evidence:

Level IV, Prognostic study.