In the realm of orthopedic trauma, calcaneal fractures—breaks occurring in the heel bone—represent a significant clinical challenge, not only due to their complex anatomical structure but also because of the profound impact they can have on a patient’s functional mobility and overall quality of life. A recent study published in BMC Psychiatry sheds new light on an often-overlooked dimension of this injury: the psychological health of patients before and after surgical intervention. This comprehensive investigation by researchers at Honghui Hospital in Xi’an strategies around the intricate interplay between mental health and physical recovery, revealing that preoperative anxiety and depression may critically shape postoperative outcomes.
Calcaneal fractures frequently demand complex surgical repairs, often necessitating careful anatomical reconstruction to restore foot function and enable patients to resume normal ambulation. While much emphasis has traditionally been placed on the biomechanical and rehabilitative aspects of treatment, emerging evidence now underscores the essential role of psychological status both prior to and following surgery. Fear, anxiety, and depressive symptoms are common among patients facing surgery, but their direct influence on clinical prognoses, particularly in the context of calcaneal fractures, has remained poorly elucidated until this point.
The study recruited a cohort of 67 patients who underwent surgical treatment for calcaneal fractures at the Foot and Ankle Surgery Department in Honghui Hospital between November 2019 and September 2022. This timeframe allowed for a longitudinal assessment, capturing both preoperative psychological states and long-term postoperative outcomes. Researchers stratified participants into two groups: those with identifiable anxiety or depression symptoms before surgery (Group A) and those without these symptoms (Group B). The Hospital Anxiety and Depression Scale (HADS), a validated psychometric tool, was employed alongside physical functional evaluations including the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) Score to quantitatively monitor patient progress.
Intriguingly, nearly half of the patients (49.25%) exhibited significant preoperative psychological distress. This startling prevalence highlights the necessity of integrating mental health screening into pre-surgical protocols for orthopedic trauma patients. Both groups demonstrated marked improvements in pain reduction and functional scores postoperatively, affirming the overall efficacy of surgical intervention in restoring foot mechanics. However, those with preoperative anxiety or depression experienced less favorable prognoses, suggesting that psychological morbidity imposes a tangible barrier to optimal recovery.
These findings have profound implications for clinical practice. The nexus between mental health and physical healing is intricate and multifaceted, involving neuroendocrine, immunological, and behavioral pathways. Psychological distress can exacerbate pain perception, diminish adherence to postoperative rehabilitation protocols, and impair immune function, potentially delaying wound healing and prolonging disability. Hence, psychological assessments should be considered integral components of perioperative care for patients with calcaneal fractures.
Moreover, this study advocates for a multidisciplinary approach where mental health professionals work alongside orthopedic surgeons to devise tailored interventions. Addressing anxiety and depression preemptively—through cognitive behavioral therapy, pharmacological treatment, or supportive counseling—could serve as an adjunct to surgical care, enhancing patient resilience and improving functional outcomes. Such integrative strategies may also reduce healthcare costs by minimizing complications and accelerating return to work or daily activities.
The methodology employed in this research manifests rigorous clinical acumen. By leveraging validated scales such as the HADS, the researchers ensured precise measurement of psychological symptoms, while the incorporation of objective surgical outcome metrics facilitated robust correlation analyses. The longitudinal nature of the follow-up further strengthened the evidence base, enabling observation of sustained effects beyond the immediate postoperative period.
Nevertheless, the study acknowledges certain limitations, including the relatively modest sample size and the potential influence of confounding variables such as socioeconomic status, comorbidities, and varying rehabilitation adherence rates. Future research with larger, more diverse patient populations and randomized control designs could further delineate causal mechanisms and optimal intervention protocols.
From an orthopedic perspective, these insights emphasize that healing extends beyond bone mending and soft tissue repair. Psychological wellbeing constitutes a pivotal determinant of success, mandating a paradigm shift that recognizes the patient as a holistic entity rather than a mere anatomical problem. This evolution in treatment philosophy aligns with a growing body of evidence in other surgical disciplines underscoring the mind-body connection.
Furthermore, the study’s revelations might stimulate innovation in preoperative patient education, encouraging surgeons to address mental health proactively, thereby reducing patient anxiety and improving surgical preparedness. The data also advocate for routine screening protocols at trauma centers to identify high-risk individuals who may benefit most from targeted mental health interventions.
In conclusion, this landmark research published in BMC Psychiatry compellingly demonstrates the profound effect of preoperative psychological health on the trajectory of recovery in patients undergoing surgery for calcaneal fractures. By integrating mental health evaluations into orthopedic care pathways, clinicians can better predict outcomes and optimize treatment plans, ultimately enhancing both physical and psychological patient wellbeing. As the medical community increasingly embraces interdisciplinary approaches, the lessons from this study herald a new era in orthopedic trauma management centered on holistic healing.
Subject of Research: Patients with calcaneal fractures undergoing surgical treatment, focusing on preoperative and postoperative psychological health and its impact on functional recovery.
Article Title: Analysis of preoperative and postoperative depression and anxiety in patients with calcaneal fractures.
Article References:
Xu, J., Cao, S., Hu, D. et al. Analysis of preoperative and postoperative depression and anxiety in patients with calcaneal fractures. BMC Psychiatry 25, 736 (2025). https://doi.org/10.1186/s12888-025-07184-6
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