Aims: Traditionally in surgery, and this is especially true in orthopaedic foot surgery, is not paid much attention to patient’s emotions, not considering how specific personality traits could affect pre and post surgical management. Following the guidelines of WHO about the treatment of pain and in order to optimize the clinical management of patients who complain of painful foot disorders such as hallux valgus, we studied the relation between level of anxiety, perception of pain and memory pain before and after the surgical procedure.

Methods: In the period 2000 and 2004 we studied 88 patients who were treated with distal metatarsal osteotomy for correction of hallux valgus. In order to evaluate anxiety trait level we selected one of the most frequently employed tests in clinical medicine (S.T.A.I. Y2). To quantify the amount of pain, due to such pathology in the pre and post surgical period, FFI test (visual analogous) and a questionnaire on pain memory, were employed. Pain was studied longitudinally, in the following steps: presurgery, immediately postsurgery, daily in the first four days, and at one and two weeks interval after the procedure. The use of analgesic drugs in the first two weeks was recorded. Two years later the same patient were recalled in order to collect data related to the clinical outcome and pain memory persistence.

Results: A subgroup of 33 patients showed an high anxiety trait level (score > 43), the remaining 50 patients had a score in the normal range.

The statistical analysis of the data shows a direct correlation between anxiety level and pain perception in the pre surgical period. Furthermore, patients with higher level of anxiety showed an increased use of analgesic drugs in the post surgical period (the higher dosage prescribed on demand). The unpleasant memory persistence is however mitigated in the same group, possibly due to much drug assumption.

Conclusions: A correct management of patients with painful diseases candidated to surgical procedures should include a comprehensive psychological evaluation in order to identify their emotional state. Especially in clinical situations requiring bilateral surgical approaches is mandatory to avoid that pain could become a traumatic experience.