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.
ABSTRACT
Objetivo. Señalar la frecuente asociación de metatarso adductus y Hallux valgus en el adulto como causa de corrección insuficiente de éste tras la aplicación de técnicas quirúrgicas comunes. Material y método. Se han revisado retrospectivamente 16 casos en 15 pacientes operados de Hallux valgus entre los años 2006 y 2008, presentaban metatarso adductus clínico y radiológico y en los que se observaba una corrección de la deformidad inferior a 10°. Resultados. La corrección media presentada fue de 9°. La oblicuidad media de la primera articulación cuneometatarsiana fue de 65°. No apareció relación entre grado de metatarso adductus y corrección observada. Las mejores correcciones se obtuvieron con la osteotomía en Scarf. Discusión. Existe controversia en cuanto a la relación entre metatarso adductus y Hallux valgus. Aunque una inadecuada aplicación de las técnicas quirúrgicas es la causa más importante de fracaso en la corrección, la poca bibliografía existente y la comparación con resultados propios, nos pueden señalar esta asociación como una causa de dificultad en la aplicación de técnicas quirúrgicas convencionales. Conclusión. La presencia de metatarso adductus en un paciente adulto que va a ser operado de Hallux valgus debe ser detectada y consignada como una causa que dificulta la corrección. La planificación y la elección de la técnica deben tener en cuenta estos defectos angulares para evitar un resultado decepcionante para el paciente (AU)
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 radiologic 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 cuneometatarsal 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 (AU)
