Foot & Ankle Orthopaedics (Nov 2022)

Is There a Psychiatric Diagnosis in Chronic Ankle Instability Patients?

  • John R. Allen,
  • Caroline P. Hoch,
  • Daniel J. Scott MD, MBA,
  • Christopher E. Gross MD

Journal volume & issue
Vol. 7


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Category: Ankle; Other Introduction/Purpose: Ankle instability is an extremely common clinical entity. Chronic ankle instability (CAI) can develop in some patients, leading to continued pain and dysfunction. However, there is very limited data to date on what impact common psychiatric pathology may have on patients' experience with CAI. This study aimed to investigate the association between psychiatric diagnosis and CAI, and whether having a diagnosed psychiatric illness impacts the outcome of CAI. We hypothesized that a concomitant diagnosis of psychiatric pathology with CAI would be significantly associated with lower postoperative patient- reported outcome measures (PROMs). Methods: A retrospective review was conducted of 276 patients (280 ankles) treated between 2005 and 2021 at an academic medical center by one of three fellowship-trained foot and ankle orthopaedic surgeons, of which 56 underwent surgery and 130 had a concomitant psychiatric diagnosis (i.e., anxiety=111, depression=105, post-traumatic stress disorder [PTSD]=19, obsessive- compulsive disorder [OCD]=6, bipolar disorder [BPD]=5). Data collected included demographics, conservative treatment history, and patient-reported outcome measures (PROMs), such as Visual Analogue Scale (VAS), Brief Resiliency Scale (BRS), 12-Item Short-Form Survey (SF-12), Somatic Symptom Scale (SSS-8), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: Preoperatively, patients with these concomitant psychiatric diagnoses had worse preoperative PROMs. However, the overall cohort improved postoperatively across all PROMs. In particular, the FAOS Total score relatively increased by 35.28% (preop=57.29%, postop=77.50%, p=.011) and the FAAM Total by 49.86% (preop=45.87%, postop=68.74%, p=.027). Both improvements were significant. Of note, the relative change of pre- to postoperative FAOS and FAAM scores was greater among the mental illness group in all scores but FAOS Sports and Recreation. (Table 1) However, no postoperative PROM among the mental illness group, aside from the FAOS Symptoms and Stiffness score, was as high as the postoperative score of those without mental illness. Although patients with these psychiatric illnesses more often failed conservative measures and subsequently received surgical treatment, this was not significant. Conclusion: CAI patients with a concomitant psychiatric diagnosis improved more following surgery than those without mental illness, as measured by FAOS and FAAM scores. However, the mental illness group did not report postoperative FAOS and FAAM scores as high as those without mental illness. Furthermore, CAI patients with a concomitant mental illness more often failed conservative treatment and went on to receive surgery. Physicians should be aware of this information when counseling CAI patients with a concomitant mental illness.