Psychological factors associated with foot and ankle pain

Foot and ankle pain is common in the community. Foot pain is estimated to have a prevalence between 13 and 36% and ankle pain has an approximate prevalence of 12%. Compared to other body regions, the foot/ankle is the third most common site of self-reported joint pain for adults aged over 55 years.

The presence of foot and ankle pain is a risk factor for functional impairments such as:

• Locomotor disability
• Impaired balance
• Increased risk of falls
• Reduction or inability to do physical exercise
• Reduced health-related quality of life

"Negative psychological constructs are greater in participants with foot and ankle pain compared to those without foot and ankle pain".

Foot and ankle pain, however, is not only associated with increased risk of physical or functional impairments – but also negative emotional and cognitive factors were more common in people with foot/ankle pain compared to those without foot/ankle pain. Emotional factors such as depression, anxiety and general indicators of emotional distress are more common in people with persistent pain than in pain-free controls for a range of conditions (e.g., mixed, back, head, neck, fibromyalgia, arthritis). A significant association was also found between emotional distress with foot pain and foot function in some people with plantar heel pain.

Foot and ankle pain is generally viewed through a biomedical lens rather than applying a biopsychosocial model. Health practitioners treating foot and ankle conditions should utilise a biopsychosocial model, which describes foot/ankle pain as a result of the interaction between biological, psychological and social factors. This model shifts the focus from the pathophysiological processes associated with pain and reinforces the influence of a person’s emotional state, cognitive processes, and subsequent behaviour on pain.

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Psychological factors associated with foot and ankle pain: a mixed methods systematic review: Matthew Cotchett, Nicoletta Frescos, Glen A. Whittaker &  Daniel R. Bonanno