Clinical outcomes of subtalar arthrodesis for calcaneal fracture malunion and their association with preoperative anxiety and depression: a retrospective cohort study.
- 1Department of Foot and Ankle Surgery (Comprehensive Ward), Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China.
- 2Department of Foot and Ankle Surgery (Comprehensive Ward), Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China. [email protected].
Abstract
Background
Patients with foot and ankle disorders often experience preoperative anxiety / depression, which can adversely affect surgical outcomes. This study aimed to explore the factors influencing preoperative mental health status in patients with malunited calcaneal fractures and to evaluate the potential impact of preoperative mental health on prognosis following subtalar arthrodesis (STA).Methods
This study retrospectively enrolled 45 patients with malunited calcaneal fractures who underwent subtalar arthrodesis from January 2015 to May 2023. Demographic data were collected, and assessments using the Hospital Anxiety and Depression Scale (HADS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analog Scale (VAS) were performed. The Wilcoxon signed-rank test was used to compare preoperative and final follow-up VAS and AOFAS scores. Spearman correlation was used to analyze the associations between preoperative HADS scores and preoperative VAS/AOFAS scores, and the associations between preoperative HADS scores and final follow-up VAS/AOFAS scores. A HADS-A or HADS-D score ≥ 8 was defined as indicating anxiety/depressive symptoms.Results
A total of 39 patients (32 male, 7 female) completed follow-up. Sixteen patients (41.03%) had preoperative HADS-A or HADS-D scores ≥ 8, indicating anxiety/depressive symptoms. Significant improvements in VAS and AOFAS scores were observed at final follow-up compared to preoperative assessments (P < 0.001). Preoperative VAS scores showed significant positive correlations with both anxiety and depressive symptoms (P < 0.05), while preoperative AOFAS scores showed a significant negative correlation with anxiety (P < 0.05) but not with depression (P > 0.05). No significant correlations were found between preoperative anxiety/depressive symptoms and baseline characteristics (gender, age, BMI, disease duration; all P > 0.05). Notably, preoperative HADS scores were not significantly correlated with final follow-up VAS or AOFAS scores (all P > 0.05).Conclusions
STA effectively treats malunited calcaneal fractures, significantly improving clinical outcomes. Preoperative pain levels correlated with both anxiety and depressive symptoms, whereas functional status correlated only with anxiety. No statistically significant association was identified between preoperative anxiety/depressive symptoms and final follow-up pain relief or functional recovery in this cohort. Given the modest sample size, these null findings should be interpreted cautiously. Clinicians should prioritize preoperative pain management to alleviate psychological distress and optimize perioperative care.
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BibTeX
@article{zhao2026clinical,
title = {{Clinical outcomes of subtalar arthrodesis for calcaneal fracture malunion and their association with preoperative anxiety and depression: a retrospective cohort study.}},
author = {Hang Zhao and Jun Lu and Yi Li and Dong Hu and JunKui Xu},
journal = {BMC psychology},
year = {2026},
month = jul,
doi = {10.1186/s40359-026-05247-1},
url = {https://europepmc.org/article/MED/42928251},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical outcomes of subtalar arthrodesis for calcaneal fracture malunion and their association with preoperative anxiety and depression: a retrospective cohort study.
AU - Hang Zhao
AU - Jun Lu
AU - Yi Li
AU - Dong Hu
AU - JunKui Xu
PY - 2026
DA - 2026/07/29
JO - BMC psychology
DO - 10.1186/s40359-026-05247-1
UR - https://europepmc.org/article/MED/42928251
AB - Background Patients with foot and ankle disorders often experience preoperative anxiety / depression, which can adversely affect surgical outcomes. This study aimed to explore the factors influencing preoperative mental health status in patients with malunited calcaneal fractures and to evaluate the potential impact of preoperative mental health on prognosis following subtalar arthrodesis (STA).Methods This study retrospectively enrolled 45 patients with malunited calcaneal fractures who underwent subtalar arthrodesis from January 2015 to May 2023. Demographic data were collected, and assessments using the Hospital Anxiety and Depression Scale (HADS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, and Visual Analog Scale (VAS) were performed. The Wilcoxon signed-rank test was used to compare preoperative and final follow-up VAS and AOFAS scores. Spearman correlation was used to analyze the associations between preoperative HADS scores and preoperative VAS/AOFAS scores, and the associations between preoperative HADS scores and final follow-up VAS/AOFAS scores. A HADS-A or HADS-D score ≥ 8 was defined as indicating anxiety/depressive symptoms.Results A total of 39 patients (32 male, 7 female) completed follow-up. Sixteen patients (41.03%) had preoperative HADS-A or HADS-D scores ≥ 8, indicating anxiety/depressive symptoms. Significant improvements in VAS and AOFAS scores were observed at final follow-up compared to preoperative assessments (P < 0.001). Preoperative VAS scores showed significant positive correlations with both anxiety and depressive symptoms (P < 0.05), while preoperative AOFAS scores showed a significant negative correlation with anxiety (P < 0.05) but not with depression (P > 0.05). No significant correlations were found between preoperative anxiety/depressive symptoms and baseline characteristics (gender, age, BMI, disease duration; all P > 0.05). Notably, preoperative HADS scores were not significantly correlated with final follow-up VAS or AOFAS scores (all P > 0.05).Conclusions STA effectively treats malunited calcaneal fractures, significantly improving clinical outcomes. Preoperative pain levels correlated with both anxiety and depressive symptoms, whereas functional status correlated only with anxiety. No statistically significant association was identified between preoperative anxiety/depressive symptoms and final follow-up pain relief or functional recovery in this cohort. Given the modest sample size, these null findings should be interpreted cautiously. Clinicians should prioritize preoperative pain management to alleviate psychological distress and optimize perioperative care.
SN - 2050-7283
ER -