Analysis of Preoperative and Postoperative Psychological Status in Patients with Chronic Achilles Tendon Rupture Undergoing Flexor Hallucis Longus Transfer Surgery

Abstract Background Patients with chronic Achilles tendon rupture (CATR) often undergo flexor hallucis longus (FHL) transfer technique to restore hindfoot biomechanical function, yet postoperative outcomes exhibit significant individual variability. Although psychological disorders such as anxiety and depression occur in 40–50% of patients with chronic tendinopathy, no studies have investigated the association between preoperative mental health status and FHL transfer outcomes in foot and ankle surgery. This study aims to determine the effects of preoperative anxiety/depression symptoms on postoperative pain relief and functional recovery in CATR patients, providing a theoretical basis for optimizing perioperative psychological interventions. The purpose of this study is to investigate the impact of preoperative mental health status on treatment outcomes in patients undergoing FHL tendon transfer for CATR. Methods This study enrolled 83 patients diagnosed with chronic Achilles tendon rupture who underwent FHL tendon transfer surgery at the Honghui Hospitalbetween June 2015 and September 2023. Participants were divided into two groups based on the presence of preoperative anxiety/depression symptoms: Group A comprised patients without preoperative anxiety/depression symptoms, while Group B included those with such symptoms. Evaluations using the Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS, 0-100 mm) for pain, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were conducted preoperatively and at final follow-up. Results Among the 63 CATR patients who completed follow-up, 33 exhibited preoperative anxiety/depression symptoms, with an incidence rate of 52.38%. Both Group A and B demonstrated significant improvement in all evaluated outcome measures following FHL transfer surgery compared to preoperative assessments; however, Group B exhibited poorer overall outcomes than Group A. Conclusion FHL transfer technique can effectively restore hindfoot function in patients with CATR, and preoperative psychological status may influence postoperative recovery.