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Resumen: Introducción: La alta prevalencia de la patología del antepié genera largas listas de espera quirúrgica (LEQ). Hemos detectado un considerable número de pacientes que renuncian a la cirugía, lo que crea una importante distorsión en nuestra actividad y un elevado gasto de recursos. Nuestro objetivo es estudiar los factores relacionados con estas renuncias, así como comparar con otras patologías de alta prevalencia y tratamiento quirúrgico ambulatorio: síndrome del túnel carpiano (STC) y la meniscopatía interna (MI). Material y métodos: Estudio retrospectivo de las renuncias a la intervención sobre 2.399 pacientes incluidos en LEQ de la Unidad de Pie y Tobillo de nuestro centro para cirugía del antepié, entre enero/2014 y marzo/2018, ambos inclusive. Resultados: Hemos encontrado 389 renuncias, lo que supone un 16,22% de las inclusiones en LEQ, siendo un 84,83% mujeres. Las patologías con mayor tasa de renuncia han sido: metatarsalgia de Morton (24%) y hallux rigidus (20,16%). La patología más frecuente, el hallux valgus, registra un 15,96% de renuncias que se producen mayoritariamente entre los seis y nueve meses. En el STC y la MI, el índice de renuncias ha sido del 17,42 y del 8,92% respectivamente, con mayores tasas de renuncia en los tres primeros meses. Conclusiones: La renuncia a una intervención programada sobre el antepié registra una alta frecuencia en nuestro medio, que puede relacionarse con factores como el tipo de patología, historia natural, respuesta a intervenciones ortopédicas, el tiempo en LEQ, y otros no determinados sobre los que debemos profundizar, para racionalizar y establecer prioridades en nuestras LEQ. Abstract: Introduction: The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM). Material and methods: Retrospective study of the surgical cancellations on 2,399 patients included in the SWL of the Foot and Ankle Unit of our center for forefoot surgery, between January/2014 and March/2018, both included. Results: We have found 389 renunciations, which represent 16.22% of the inclusions in SWL, with 84.83% of women. The pathologies with the highest rate of resignation have been Morton metatarsalgia (24%) and hallux rigidus (20.16%). The most frequent pathology, hallux valgus, records 15.96% of resignations that occur mostly between 6 and 9 months. In the CTS and IM, the resignation rate has been 17.42 and 8.92%, respectively, with higher resignation rates in the first 3 months. Conclusions: The withdrawal of a scheduled intervention on the forefoot registers a high frequency in our environment, which can be related to factors such as the type of pathology, its natural history, response to orthopedic interventions, time in LEQ, and other non-specific ones on which we must investigate, to rationalize and establish duties in our SWL.

Introduction: Koutsogiannis’ osteotomy has been widely described to treat adult-acquired flatfoot. However, few articles describe its midterm follow-up. Our aim was to study clinical and radiological outcomes at least one year after surgery and to analyze whether a combined procedure on the medial soft tissue affected these outcomes. Methods: We performed a retrospective study of 30 feet of patients who underwent a Koutsogiannis’ osteotomy due to adult-acquired flatfoot stage II and “early stage III”: a stage III acquired flatfoot without any important structural deformities. The parameters studied were additional medial soft tissue procedures, clinical outcome through the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and midfoot score as well as complications and radiological measurements. Results: Sixteen cases were “early stage III” and 14 stage II. Thirteen patients underwent an associated posterior tibial tendon (PTT) revision: in three cases an end-to-end suture was possible, seven cases needed a FDL transposition, and three underwent synovectomy. Statistically significant improvement was found in the AOFAS score although no significant changes were seen radiologically. No additional benefit was found with the revision of the posterior tibial tendon. As to clinical and radiological results, no differences were found between stage II and “early stage III”. Five cases presented a mild dysesthesia but only one patient needed neurolysis. Conclusions: We consider the Koutsogiannis’ osteotomy to be a safe and effective procedure to reduce pain in patients with stage II and “early stage III” adult-acquired flatfoot.

Background To describe the frequent association of metatarsus adductus and hallux valgus in the adult foot as a cause of insufficient correction after application of common surgical techniques. Method and material A retrospective review was made of 16 cases in 15 patients with clinical and radiological metatarsus adductus operated by Hallux valgus from 2006 to 2008. In all cases, a correction of the deformity lower than 10° was observed. Results The mean postoperative correction was 9°. The mean inclination of first cuneummetatarsal joint was 65°. We did not find any relationship between Metatarsus adductus magnitude and postoperative Hallux valgus correction. The best results were observed with Scarf Osteotomy. Discussion There is controversy on the Metatarsus adductus and Hallux valgus relationship. Although poor application of the surgical techniques is the most important cause of correction failure, the limited literature references and the comparison with similar results, may show this association as a cause of the difficulty in the application of conventional surgical techniques. Poor performance of these techniques is an important cause of correction failure and must be evaluated. Conclusion Metatarsus adductus in the adult foot with Hallux valgus to be operated must be detected and seen as a deformity that is difficult to correct. Preoperative planning and choice of surgical technique must assess these angular deformities to avoid a poor result for the patient.

Trimalleolar ankle fractures can be difficult to manage and convey a high risk of long-term morbidity. The question of whether internal fixation of the posterior malleolar fragment is warranted remains open. We conducted a retrospective cohort study involving 45 patients who underwent surgical repair of a trimalleolar fracture. Our goal was to study the effect of the size of the posterior fragment on outcomes. We defined small posterior malleolar fragments as being ≤ 25% of the distal tibial articular surface as viewed on the lateral radiograph. Outcome measures included the radiographic appearance of the reduction, as well as Olerud and Molander (O&M) scores and AOFAS scores. Overall better outcomes were obtained in patients whose fractures involved ≤ 25% of the articular surface, and the difference in outcomes was statistically significant in regard to the AOFAS scores (P = .05), although not statistically significant in regard to Olerud and Molander scores and the radiographic appearance of the reduction (P = .14 and P = .45, respectively). Anatomic reduction was achieved in 73.3% of patients, but they did not have better clinical results than nonanatomic reduction patients: AOFAS (P = .14), O&M (P = .38), radiographic appearance (P = .74).