Improvement of Depressive Symptoms Following Surgical Correction of Hallux Valgus and Hallux Rigidus via 1st MTP Fusion

Abstract

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Psychiatric comorbidity has been shown to significantly impact postoperative course, leading to increasingly complicated hospitalizations, increased pain, and worse overall patient outcomes. Achieving adequate pain management is paramount in restoring mobility and ultimately reaching treatment goals, making an understanding of the interplay between psychiatric conditions and orthopedics vitally important. Specifically, deformity of the first MTP joint has been associated with increased psychiatric symptoms preoperatively. However, despite this particular population's vulnerability to depressive symptoms, the effects of surgical correction on mental function outcomes have not been well observed. The purpose of this study was to assess the association of psychotropic medication use in patients with diagnoses of hallux rigidus and hallux valgus undergoing first MTP fusion and differences in patient-reported pain and functionality scores. Methods: A retrospective analysis of prospectively collected patient outcomes for those undergoing MTP fusion for hallux valgus and hallux rigidus between August 1, 2015, and July 1, 2018, was conducted. A total of 95 patients were included in the study. Demographics and surgical data were collected from a review of the electronic medical record, and patients were grouped based on chronic use of psychotropic medications at the time of surgery. Patient-reported VAS, SF-36 Mental Component Scores (MCS), and Physical Component Scores (PCS) scores were collected at preoperative and routine 6-month and 12-month postoperative follow-up clinic appointments. Categorical variables were compared using Pearson's chi-squared test. For normally distributed data outcome scores were compared using the independent sample t-test while non-normal data comparisons were made with the Mann-Whitney U test. For all statistical tests, assumptions of α <.05 and β =.8 were made. Results: The average age of the patients in our cohort was 63.3 (range, 39 - 83), with 42 patients in the psychotropic medication (MED) and 53 patients non-psychotropic medication (NO MED) cohorts. Mean time to final follow-up was similar between NO MED and MED groups (p=.987). No differences in mean VAS scores were detected at preoperative (p=.455), 6-month (p=.505), nor 1-year (p=.269) visits. Similarly, no differences in SF-36 PCS were detected at preoperative (p=.087), 6-month (p=.314), nor 1- year (p=.103) postoperative visits. Patients taking psychotropic medications had significantly lower mean SF-36 MCS at preoperative and 6-month postoperative visits (p=.004, p=.033, respectively). No difference in mean mental component score was detected at the 1-year postoperative visit (p=.184). Conclusion: This study is the first to examine the surgical outcomes of patients undergoing 1st MTP fusion for hallux rigidus and hallux valgus while concurrently taking psychotropic medications. SF-36 mental component scores were depressed at preoperative baseline in the psychotropic medication cohort and improved postoperatively to a level similar to that of their non- psychotropically medicated peers. These findings suggest that psychiatric diagnoses should be considered in the discussion of conservative vs. surgical management of hallux valgus and rigidus, as a secondary benefit of surgical correction may be partial relief of depressive symptoms.