It is a remarkable book for its content, presentation and impact, influencing in the latter aspect the undoubted morbid that gives it its apparent “heterodoxy”.
Regarding its content, it is exemplary. Each technique, instrumental, preoperative planning, pathology, anatomical preparation or radiological image is accompanied by a clear and descriptive text, which avoids speculations or marginal comments. The indications are correctly indicated and the clinical cases help to better understand each technique. It would, in any case, have required the authors to expose the complications most frequently observed, for the warning and knowledge of the neophytes.
The presentation is excellent, with an adaptation between text and iconography that facilitates the understanding of the point to be treated.
Regarding its impact, it is evident that the so-called “MIS” techniques are making their way into the therapeutic panoply of orthopedic surgery, fundamentally supported by the success of arthroscopic surgery. As the authors point out and Dr. Viladot underlines (prologue of the work) “these techniques are a valid alternative to open forefoot surgery, provided that the indications are correct and the surgeon has a good preparation and has the right material for this type of surgery. ”
I will only add that, contrary to what may seem for its attractive and didactic presentation, it is not risk-free and simpler than traditional open surgery; on the contrary, an orthopedic surgeon must practice it, with sufficient surgical and morphological foundations to develop it successfully.
Dr. De Prado and his collaborators provide an outstanding service to practitioners of this type of surgery, confirming with this work the quality and commitment of the Spanish School of foot surgery, arising from the tail of Antonio Viladot.
The well-known book by Drs de Prado, Ripoll and Golanó, “Percutaneous Foot Surgery”, has been published and updated in English, a publication that has marked a before and after in the concept of treatment of injuries and, above all, deformities of the forefoot. As Nicola Maffulli points out in the introduction, minimally invasive surgery is not entirely new but was ordered in the work of Mariano de Prado and collaborators in its first edition in Spanish, which unfortunately was inaccessible for many surgeons of other languages.
The years, the experience and above all the evaluation and satisfaction of the patients, have allowed to prepare this edition in English (completed with very careful didactic schemes and photographs of an extraordinary quality) that will achieve international diffusion. No one doubts that Mariano de Prado is a reference in percutaneous foot surgery and it is well known the courage he had to be surprised with what he discovered of American chiropody surgery.
But what is reflected in this manual, essential for any foot surgeon, is that the authors have also managed to establish precise indications, the right technique with anatomical reasoning, and has broken the dichotomy between open surgery and percutaneous surgery, as Ramón Viladot well acknowledges in the prologue. It is not posible to continue talking about two styles or schools in foot surgery, the important thing is to establish the correct indication, with the most appropriate technique and that is best mastered.
Every surgical technique has its history and many times behind the best known names appear others that many years before had been pioneers. Bibliographic searches show that almost always there was a previously unsuspected. In the case of percutaneous foot surgery, there were many surgeons and podiatrists who dared to operate the deformities of the fingers with small incisions and specially designed instruments.
However, if we want to establish a starting point for the story that now concerns us, we will not be wrong to remember Dr de Prado’s meeting with Stephen Isham, who had designed his percutaneous technique for hallux valgus, based on biomechanical principles, with some very careful, precise and reasoned surgical steps. In Murcia, doctors De Prado and Ripoll, began to intervene the first patients following the technique of Isham. Finally, the Spanish edition and the publication of this book that we are now presenting are the confirmation of the silent work carried out over many years.
Spain has had a valuable tradition of foot surgeons. It could be pointed out a long list of them. Mariano de Prado, as the head of the group that publishes the book, has known how to walk with these techniques that now so wonderfully describes and well documentes, through a path of initial incomprehension he has been able to dismantle thanks to his experience, to the didactic training courses model he has designed and the two published manuals.
In this journey, carried with dedication, enthusiasm and an exquisite education, these doctors have known how to convince and discuss without losing any friendship, finding a space for percutaneous foot surgery that every orthopedic surgeon should know.
This book, which defines surgical techniques in the foot and its indications with a perfect anatomical base, is probably one of the best treatises existing today regarding Orthopedic Surgery and Traumatology. As a whole, it represents all the available knowledge in a specific area of foot pathology and explains percutaneous techniques for most common surgical problems of the foot in daily practice: hallux valgus or rigidus, metatarsalgia of mechanical origin, claw toes, Morton syndrome, plantar fasciitis, calcaneal spur, tailor’s bunion and several common problems of the posterior tarsus.
The work is edited at a particularly appropriate time in which the experience of the authors’ years is already a reality, with a great deal of proven casuistry and numerous introductory and advanced courses taught in the last five years.
While there is still controversy regarding the suitability and validity of percutaneous foot surgery as a solid alternative (which leads to a confrontation with classical open surgery), the orientation offered by this book is verifiable by all those who share the day to day of the consultation and the operating theater activity of the authors.
The title proposal, starting with the techniques, exposes the current situation of the best existing procedures, already contrasted, and does it in an integral and step by step way so that any previously initiated specialist can prepare and place the patient in an appropriate way, anesthetize it and follow the technique correctly.
The schemes, macroscopic photos and radiographs are exceptional and perfectly combined, to be explicit in a very didactic way. The anatomical images, with the classic excellence of everything that the Golanó School does in our field, are especially good, perfect to sustain the base of the rest.
Behind the indications, the criteria that are set out can be considered as the first line in terms of the objective that surgical gestures should pursue and the type of correction that is appropriate for each case, clearly indicating that there are other ways to achieve the same therapeutic goals, other techniques for open or percutaneous surgery that may be equally suitable; the ones in the book are those usually handled by authors with results already widely disclosed with proven effectiveness.
Once the criteria for solving specific problems have been established, the techniques follow a logical sequence and are explained by showing each step in detail, with perfect images that guide the reader step by step in the execution of the different techniques, including the postoperative bandage technique that is a capital point in the set of procedures, to maintain the corrections obtained.
It is also very useful (and it is done with the same didactic style), the explanation of the patient’s position, preparation and choice of instrumental details for each technique. Perhaps, as a matter of fact, it may seem too easy and the reader does not at first realize that there is a need for a general training in foot surgery and it may not be easy to avoid problems if one goes out of the way marked in each technique.
In brief, this treatise is a round, impeccable work, about surgical techniques supported by a good criterion of indication and an optimal anatomical base, without any “but”, which will mark a milestone in the field of Orthopedic Surgery literature and we consider it essential for all surgeon who is dedicated to the pathology of the foot.
For a non-Spanish speaking reviewer this is a fascinating book. In fact the figures are so good that anyone can enjoy the feeling of being able to understand the language. The anatomical preparations by professor Golano illustrate the surgical procedures well.
“Key hole surgery” has attractions for the surgeon and for the pacient. Arthroscopic surgery has allowed the use of case facilities for patients who 40 years ago might have spent 10 days in hospital. Hip and knee replacement are being increasing performed using a minimal incision, although the risk of complications such as deep vein thrombosis has not been demonstrably reduced. Should foot and ankle surgeons be moving in the same direction?
De Prado and colleagues certainly make percutaneous surgery of the foot look attractive. Forefoot surgery is well covered with short chapters on plantar fascitis and the Haglund deformity only for the hindfoot. The techniques described are comprehensive, including popular procedures such as the scarf osteotomy for hallux valgus and citing many publications by Barouk and Weil on this procedure. This type of surgery is widely used but not to my knowledge by percutaneous surgery. What is needed of course are prospective studies to show that percutaneous surgery is just as good, if not better, than the conventional approach.
This volume may not convert all foot surgeons to change their practice. Even so it is well worthy of study. Non-Spanish speakers should not be deterred!