Is it all in my head? Delineating the contribution of psychological health variables to pain severity in people with non-urgent foot/ankle complaints referred to an orthopaedic department

Miss Caitlin Swalwell1,2, Dr Matthew Holt2, Dr Gayle H Silveria3, Prof Vivienne Tippett1, Dr Tom P Walsh1,2, Dr Simon Platt2

1Queensland University Of Technology, Kelvin Grove, Australia, 2Gold Coast University Hospital, Southport, Australia, 3Lyell McEwin Hospital, Elizabeth Vale, Australia

Background: Australians with non-urgent, chronic foot/ankle pain are frequently referred to orthopaedic departments. However, waiting-times are long and surgical conversion rates are low and as such, allied health practitioners (AHPs) are increasingly enlisted to provide clinical triage prior to surgical evaluation. Given the multifactorial nature of pain, this study aimed to i) determine the prevalence of compromised psychological health features, and ii) delineate the contribution and relative importance of these features to foot/ankle pain severity in people referred to public-sector orthopaedics.

Methods: People with non-urgent foot/ankle complaints referred to the Gold Coast University Hospital were recruited over a 12-month period. Participants completed questionnaires relating to their demographics, psychological health (depressive symptoms, central sensitisation syndrome (CSS), pain catastrophising), and foot/ankle pain/disability (Manchester-Oxford Foot and Ankle Questionnaire). Participant characteristics were summarised descriptively, and hierarchical multiple regression was used to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of demographic variables (age, sex, BMI).

Results: One-hundred and seventy-two adults were recruited (64.0% female, median (IQR) age 60.9 (17.7) years, and BMI 27.6 (7.5) kg/m2). Compromised psychological health was prevalent: 48.3% had depressive symptoms, 38.4% had CSS and 24.4% were pain catastrophisers. Demographic variables accounted for 11.7% of the variance in foot/ankle pain severity, and psychological variables accounted for an additional 28.2%. Pain catastrophising was the largest unique predictor (14.4%).

Conclusions: Over one-third of foot/ankle pain severity was uniquely accounted for by pain catastrophising. Podiatrists or other AHPs providing orthopaedic triage may benefit from training to recognise catastrophising behaviours.


Caitlin is a current fourth-year Podiatry student, undertaking her Honours at QUT. She has a BSc (Biomedical Science), DipArts (Psychology), and has contributed actively to UQ’s human anatomy and dissection program since 2011. Caitlin has always been interested in research, and is particularly interested in the multifactorial nature of complex pain presentations.

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