Patients’ Experiences of their Forefoot Problem in Hallux Valgus and/or Hallux Rigidus
: A triangulated longitudinal cohort study

  • Lorelle Dismore

Student thesis: Doctoral Thesis


Foot problems are associated with greater burden of pain, disability and decreased health-related quality of life. Orthopaedic surgery is framed within a medical model of surgery yet disabling foot pain is likely to be multifactorial in origin. Pain catastrophizing (PC) and other psychosocial variables moderate surgical outcomes. However, there is limited evidence of the role of catastrophizing in moderating forefoot surgical outcomes and a lack of understanding of patients’ experiences. The aims of this study were to explore patients’ experiences of their forefoot problem in hallux valgus and/or hallux rigidus longitudinally using a) validated measures, b) qualitative interviews supported by life grids to c) triangulate to gain an overall understanding of patients’ experiences. Orthopaedic practitioners were interviewed to explore their experiences of providing care, thoughts on catastrophizing, and use of psychosocial interventions in surgical practice. Sixteen patients and fourteen orthopaedic practitioners participated. Patients completed outcome measures (PC, patient reported outcome measures, depression, anxiety, stress, coping, social support, personality and pain beliefs) and took part in semi-structured interviews pre-surgery, and at 3-, 6- and 12-months post-surgery. Life grids were used as a tool to aid data collection and supplement the semi-structured interviews.
Descriptive analysis identified PC scores were linked to PROMs and other psychosocial variables. Pre-surgery, thematic analysis generated three themes including, the physical and psychological impact of pain, the decision-making process and body-image, the-self and self-identity. Post-surgery, thematic analysed generated six themes including, factors affecting women’s body-image, informational needs and management of patient expectations, the unknown causes of problems and not feeling listened too, factors contributing to regaining normality, psychological impact of a forefoot condition and factors contributing to changes in pain and discomfort. Interviews with orthopaedic practitioners revealed that pain expressions and behaviours affect surgeon’s decision-making process, a service gap in surgical care and the acceptability of a screening tool to identify ‘at-risk’ patients.
Forefoot problems are multifactorial and present many issues for patients impacting on their physical and psychosocial health. The women reported an altered body-image as a result of inactivity and gaining weight and were limited in their clothing and footwear choices. Lack of post-operative aftercare and unmet patient expectations were experienced, whilst healthcare communication affected satisfaction with care. Surgeons reported challenges in identifying who is likely to reach optimal versus suboptimal outcomes. They supported the use of interventions in the surgical care pathway. The findings have highlighted the importance of shifting from a medical model of care towards a biopsychosocial model in the management for forefoot problems. Interventions may include a multidisciplinary approach with support from allied health professionals.
Date of Award1 Dec 2022
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorKatherine Swainston (Supervisor) & Anna Van Wersch (Supervisor)

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