Effect of Psychotropic Medications on Hammertoe Reconstruction Outcomes

Abstract

Background: Hammertoe deformities can seriously affect activity level and footwear. The use of prescription, mood-altering medications is very common, with some estimates as high as 25% of the population. Mood disorders, especially depression, negatively affect the results of medical and operative treatments. This study assessed the relationship of mood-altering medication use with the outcomes and complications of operative reconstruction of hammertoes. Methods: Data were prospectively collected from 116 patients who underwent hammertoe reconstruction, including demographic information, medical history, the use of mood-altering psychotropic medications (antidepressants, anxiolytics, hypnotics, and mood stabilizers), and postoperative complications. Preoperative patient-reported outcomes were measured using the visual analog scale (VAS) for pain and Short Form Health Survey (SF-36), which were repeated at 1-year follow-up. Results: A total of 36.2% of patients were taking psychotropic medications. Medication and nonmedication groups had similar pain VAS and SF-36 Physical Component Summary (PCS) scores before and after surgery. Compared with nonmedication patients, patients on psychotropic medications had significantly lower SF-36 Mental Component Summary (MCS) scores preoperatively ( P = .001) and postoperatively ( P = .006), but no significant difference in the change in MCS (ΔMCS) from preoperative to postoperative. Psychotropic medication use was associated with superficial wound infections ( P = .048), but not other complications. Conclusions: Patients taking psychotropic medications were equally likely to benefit from forefoot reconstruction as nonmedication patients. Preoperative and postoperative PCS and VAS were not significantly different between medication and nonmedication groups. Although the medication group had lower absolute MCS, they reported the same magnitude of improvement in MCS (ΔMCS) as the nonmedication group. Level of Evidence: Level II, prospective cohort study.

Association of First Metatarsal Phalangeal Joint Fusion for Hallux Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking Psychotropic Medications

“…Like the present study, those patients endorsed comparable postoperative satisfaction and symptom improvement to patients without depressive symptoms 1 year after surgery. Additionally, Maidman et al 20 looked at psychotropic medication’s influence on outcomes after hammertoe reconstruction. In their series of 116 patients, 36% of which were on psychotropic medications, there were no differences in pre- and postoperative VAS and PCS scores between medicated and nonmedicated groups (preoperative VAS: nonmedicated = 4.3, medicated = 4.6; postoperative VAS: nonmedicated = 1.5, medicated = 1.8; preoperative PCS: nonmedicated = 62.5, medicated = 54.6; postoperative PCS: nonmedicated = 73.1, medicated = 65.4).…”

“…3,14,16,33 Pain management in orthopaedic surgery is paramount in restoring mobility and reaching treatment goals, making a solid understanding of psychiatric conditions in the operative setting vitally important. 1,4,11,20…”

“…3,14,16,33 Pain management in orthopaedic surgery is paramount in restoring mobility and reaching treatment goals, making a solid understanding of psychiatric conditions in the operative setting vitally important. 1,4,11,20 Difficulties associated with treating patients carrying psychiatric diagnoses are pervasive and well documented in the surgical setting. Diagnoses of depression and anxiety have been associated with longer hospitalizations and increased total costs of care after surgery.…”

“…8,32 Even with these known disparities in orthopaedic results and a patient population at high risk for psychiatric comorbidity, sparse literature exists examining the relationship between surgical outcomes in chronic foot and ankle conditions and concurrent psychiatric care. 20,26 Pathologies of the first toe can cause patients significant physical and psychological distress. The deformities associated with these diagnoses can be mobility limiting and negatively impact body image-for instance, the severity of hallux valgus deformity has been associated with increased depressive symptoms preoperatively.…”

“…8,32 Even with these known disparities in orthopaedic results and a patient population at high risk for psychiatric comorbidity, sparse literature exists examining the relationship between surgical outcomes in chronic foot and ankle conditions and concurrent psychiatric care. 20,26…”