Background/Purpose:

While a number of risk factors for foot pain are established, the relation between depression and foot pain has not been well studied. The purpose of this study was to examine the associations of foot pain and severity of foot pain with depressive symptoms in a population-based study of older adults.

Methods:

A validated foot assessment and the 20-item CES-D questionnaire were administered to Framingham Foot Study (2002-08) participants. Age (years) and body mass index (BMI, kg/m²) were also collected. Foot pain was queried: “On most days, do you have pain, aching or stiffness in either of your feet?” Severity of foot pain was categorized as: none (referent), mild, moderate or severe pain. CES-D scores ≥ 16 were considered indicative of significant level of depressive symptoms. Sex-specific logistic regression was used to calculate odds ratios and 95% confidence intervals for the association of foot pain (y/n or severity of foot pain) with depressive symptoms (y/n) adjusting for age and BMI. In a subset of participants, further models adjusted for leg pain (hip, knee, ankle), back pain, or other joint pain (neck, shoulder, elbow, wrist).        

Results:

Of the 3321 participants (mean age: 66 ± 10 years), 1464 were men (BMI: 28.9 ± 4.7 kg/m²) and 1857 were women (BMI: 28.0 ± 6.0 kg/m²). 21% men and 27% women had depressive symptoms (CES-D score ≥ 16). Men with moderate foot pain vs. none had 2-fold increased odds (Table) of reporting depressive symptoms; men with severe foot pain had a 4-fold increased odds, independent of age and BMI. Women showed a similar trend in which women with moderate foot pain had 2-fold increased odds of depressive symptoms, and women with severe foot pain had 3-fold odds, independent of age and BMI. For both men and women, mild foot pain showed increased odds (ratios of = 1.3 and 1.4 respectively), but was only statistically significant for women (p = .046).  Models considering other regions of pain attenuated the odds ratios (Table); pain variables were non-significant for men, while in women, back pain (p = .007), other pain (p = .019) but not leg pain (p = .775) added to the model.

Conclusion:

Severity of foot pain, adjusting for age and BMI, was significantly associated with the prevalence of depressive symptoms in our study (i.e., those reporting worse foot pain were more likely to report depressive symptoms). Adding joint pain at other regions attenuated but did not change the pattern of results. Future studies should investigate the longitudinal aspects of the severity of foot pain and depressive symptoms in older adults.

Table: Odds ratios and 95% confidence intervals for the association between severity of foot pain and depressive symptoms, stratified by sex, and adjusted for age and BMI.*
	Men (n = 1464)		Women (n = 1857)
	n (%)	OR (CI)	n (%)	OR (CI)
Foot pain (y/n)	277 (19)	1.84 (1.36, 2.48)	543 (29)	1.93 (1.55, 2.45)
Severity
No foot pain (referent)	1187 (81)	1.0	1314 (71)	1.0
Mild foot pain	114 (8)	1.26 (0.79, 2.02)	208 (11)	1.40 (1.01, 1.94)
Moderate foot pain	126 (9)	1.88 (1.25, 2.86)	233 (13)	2.09 (1.55, 2.82)
Severe foot pain	37 (2)	4.34 (2.26, 8.48)	102 (5)	3.08 (2.02, 4.68)
Models further adjusted for leg pain, back pain and other joint pain.
	n (%)	OR (CI)	n (%)	OR (CI)
Foot pain (y/n)	198 (21)	1.56 (1.09, 2.23)	370 (31)	1.54 (1.17, 2.06)
Severity
No foot pain (referent)	746 (79)	1.0	824 (69)	1.0
Mild foot pain	87 (9)	0.91 (0.54, 1.55)	141 (12)	1.08 (0.73, 1.59)
Moderate foot pain	81 (9)	1.87 (1.14, 3.06)	152 (13)	1.69 (1.16, 2.45)
Severe foot pain	30 (3)	3.64 (1.71, 7.75)	77 (6)	2.53 (1.54, 4.15)
*Depressive symptoms dichotomized as CES-D score ≥ 16 or <16.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/severity-of-foot-pain-is-linked-to-the-prevalence-of-depressive-symptoms-the-framingham-foot-study/