[Translated article] The effect of showing preoperative photographs on patient satisfaction following forefoot surgery.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our centre. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

The effect of showing preoperative photographs on patient satisfaction following forefoot surgery. / Influencia de la fotografía preoperatoria en el grado de satisfacción en pacientes postoperados de cirugía de antepié.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our center. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p-value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles / Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy

OBJETIVO: La osteotomía calcánea con cuña de sustracción dorsal tiene como objetivo reducir la longitud del calcáneo, elevando la inserción del tendón de Aquiles, reduciendo así la tensión en su inserción por la verticalización del calcáneo. El objetivo del estudio es evaluar los resultados clínicos de esta osteotomía en pacientes con tendinopatía insercional de Aquiles y un ángulo de inclinación del calcáneo elevado. MATERIAL Y MÉTODOS: Estudio retrospectivo de 18 pacientes con diagnóstico de tendinopatía insercional del tendón de Aquiles. Realizamos una doble osteotomía calcánea en forma de cuña dorsal, exéresis de esta y síntesis con 2 tornillos canulados. Se evaluaron los resultados clínicos-funcionales mediante las escalas EVA, AOFAS, VISA-A y satisfacción del paciente pre- y posquirúrgicas. Los parámetros radiológicos analizados fueron el ángulo de inclinación del calcáneo, la longitud del calcáneo y ángulo de Fowler-Philips. Se realizó un análisis estadístico mediante Stata 15. La media de seguimiento fueron 18,3 meses (rango 14-36). RESULTADOS: Todos los pacientes presentaron mejoría objetiva de los síntomas y de las escalas EVA (de 8,25 a 2,16 puntos) y AOFAS (de 41,5 a 86,5 puntos) con significación estadística (p < 0,05). La persistencia de calcificaciones intratendinosas en las radiografías postoperatorias no influyó en la mejoría sintomática. CONCLUSIONES: Con los resultados obtenidos consideramos que la osteotomía calcánea con cuña de sustracción dorsal es una técnica alternativa válida en el tratamiento de la tendinopatía insercional de Aquiles, sobre todo en los casos con un ángulo de inclinación del calcáneo elevado

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy. / Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles.

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.

Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos / Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report

Objetivo: Presentamos los resultados de una serie de casos de pie de Charcot tratados mediante cirugía en un solo tiempo con fijador circular estático. Material y método: Revisión retrospectiva de 10 casos tratados con fijación externa circular estática desde 2016, con los siguientes criterios de inclusión: 1) deformidad asociada a alguno de los siguientes signos: úlcera cutánea, osteomielitis o inestabilidad articular; 2) neuropatía periférica, y 3) fallo del tratamiento ortopédico previo. Criterios de exclusión: 1) obstrucción vascular periférica sin revascularizar; 2) incapacidad para cumplir el tratamiento; 3) pacientes no deambulantes, y 4) contraindicación médica para la cirugía. De los 10pacientes, 7 hombres y 3mujeres, 6tenían afectación del pie izquierdo y 4del derecho. La edad promedio de nuestros pacientes era de 58 años (rango 39-71). Valoramos además estadio de Eichenholtz, clasificación de Brodsky, presencia de úlceras cutáneas, osteomielitis e inestabilidad. Todos los pacientes fueron tratados con fijación circular con un seguimiento medio de 17 meses (rango 11-24 meses). Postoperatoriamente, valoramos la conservación de la extremidad, curación de la úlcera cutánea, estabilidad e índice de reulceraciones. Resultados: En todos los pacientes se consiguió un pie plantígrado funcional, curación de la úlcera cutánea sin recidiva de la misma. Cuatro casos presentaron infección cutánea en las agujas, resuelta con cuidados locales. Evidenciamos rotura de aguja en 2 casos, que no requirieron recambio. Todos los pacientes están satisfechos y optarían por la misma técnica, de ser necesario. Conclusiones: En el pie de Charcot los objetivos son evitar la amputación y conseguir un pie plantígrado funcional, sin úlcera cutánea. La cirugía en un solo tiempo con fijación externa circular estática es una técnica reproducible en nuestro medio, válida además para aquellos casos en que la fijación interna puede estar contraindicada

Objective: We present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. Material and method: Retrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. Exclusion criteria: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. Results: In all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. Conclusions: of the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer. Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option

Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report. / Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos.

OBJECTIVE: We present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. MATERIAL AND METHOD: Retrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. EXCLUSION CRITERIA: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. RESULTS: In all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. CONCLUSIONS: of the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer. Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option.