Flexor Tenotomy for Plantar Ulcers of the Toes

NewsBot · Feb 9, 2010

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Functional Outcome and Patient Satisfaction after Flexor Tenotomy for Plantar Ulcers of the Toes.
Schepers T, Berendsen HA, Hok Oei I, Jan Koning.
J Foot Ankle Surg. 2010 Feb 3. [Epub ahead of print]

Ulcers of the toes may cause a severe physical burden, especially in patients with diabetes, in whom they occur most frequently. Several treatments have been proposed for the underlying anatomical abnormalities, but they vary in effectiveness. We evaluated our results in using flexor tenotomy to treat ulcers with underlying flexible clawing of the toes. For 42 toes from 23 patients, 15 of whom were diabetic, all ulcers healed. The mean healing time was 4 weeks (range, 1-8 weeks), the mean follow-up was 11 months (range, 1-27 months), and one recurrence and one complication occurred. Postoperative American Orthopaedic Foot Ankle Society Midfoot scores were available for 15 patients: the mean was 77 (range, 43-100). The mean visual analogue scale (VAS) for patient satisfaction increased from 3.9 points (range, 0-10 points) preoperatively to 7.7 (range, 5-10 points) postoperatively. Flexor tenotomy is a simple treatment with low complications and recurrence rates and provides good-to-excellent functional outcomes in treating flexible clawing of the toes and the associated ulceration
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NewsBot · Mar 20, 2014

Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus.
Rasmussen A, Bjerre-Christensen U, Almdal TP, Holstein P.
J Tissue Viability. 2013 Aug;22(3):68-73. doi:

INTRODUCTION:
The purpose was to examine the effectiveness of flexor tenotomy in a modified technique to prevent and heal neuropathic and neuroischaemic pressure ulcers on the tip of the toe in claw- or hammer-toe deformities in people with diabetes.
PATIENTS AND METHODS:
A consequetive 4 years series of 38 patients was retrospectively studied. Percutaneous tenotomy on the superficial and deep flexor tendons was performed in 65 toes through a small transverse plantar stab incision just proximal to the web level. There were 16 (42%) patients with 27 ulcerated toes and 22 (58%) patients with 38 toes with impending ulceration. Ten patients had neuropathic ulcers and six patients had neuro-ischaemic ulcers. Sixteen patients (42%) had macrovascular disease. Ten (26%) had proliferative rethinopathy, 7 (18%) macroalbuminuria and 18 (47%) microalbuminuria.
RESULTS:
All surgical incisions healed uneventfully. Twenty-five (93%) of the toe ulcers healed in median 21 days (range 7-224 days). Three patients had recurrence of the ulcer. There were no infections in the incisions or toe amputations. No patients treated with preventive tenotomy experienced toe ulceration. No complications were recorded in neuro-ischaemic ulcers. During the follow up period of median 31 months (range 2-48 months) 33 other ulcers were recorded in 18 patients (47%). One of these developed a transfer ulceration under the adjacent metatarso-phalangeal joint and another had a late pressure ulcer on a neighbouring toe. The other 31 ulcers were not related to ulcers treated with tenotomy.
CONCLUSION:
Tenotomy is a simple, safe and effective procedure for preventing and treating distal plantar neuropathic toe ulcers in claw toe or hammer toe deformities in people with diabetes with or without serious co-morbidity. The results suggest that tenotomy should be considered also in neuroischaemic ulcers.
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W J Liggins · Mar 21, 2014

Q. When is plantar not plantar? A. When it is apical.

Bill Liggins

NewsBot · Dec 2, 2021

Percutaneous needle flexor tendon tenotomy to prevent diabetic foot ulcers
Tessa E Busch-Westbroek et al
Ned Tijdschr Geneeskd. 2021 Sep 30;1656176.

People with diabetes and polyneuropathy often develop foot deformities, resulting in ulcers or pre-ulcerative lesions on the apex of the toes. The Dutch guideline on diabetic foot disease recommends considering a flexor tendon tenotomy to treat a distal toe ulcer, if conservative treatment fails, and to prevent a toe ulcer if a pre-ulcerative lesion is present. To our knowledge, this technique is rarely performed in the Netherlands and if used, performed with a scalpel. Recent studies show that a new, less invasive technique, the needle flexor tenotomy, is relatively safe and effective. The purpose of this procedure is reducing mechanical pressure. However, this has not yet been quantitatively demonstrated. We regularly apply this new surgical technique, including functional assessment by means of dynamic barefoot pressure measurements. We bring this surgical technique and its biomechanical effect to your attention in this article, as an effective and easy to implement intervention.
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NewsBot · Sep 25, 2022

Flexor Tendon Tenotomy Treatment of the Diabetic Foot: A Multicenter Randomized Controlled Trial
Jonas Askø Andersen et al
Diabetes Care. 2022 Sep 24;dc220085

Objective: The aim of this study was to evaluate the effects of needle flexor tendon tenotomy treatment of the diabetic hammertoe deformity.

Research design and methods: A multicenter randomized controlled trial of individuals with diabetes and ulcers or impending ulcers associated with hammertoes was performed between 1 November 2019 and 31 March 2021. Participants were stratified by the presence of ulcers or impending ulcers. Participants were randomly assigned to tenotomy and standard nonsurgical treatment or to standard nonsurgical treatment alone. Primary outcomes were time to ulcer healing and progression from impending ulcer to active ulcer.

Results: Of 224 screened participants with diabetes, 95 (59.0% men) were included. The mean follow-up was 291 ± 70 days, 28 (29.5%) had type 1 diabetes, mean diabetes (presented with 25-75% quartile) duration was 20 (13-26) years, and mean age was 67.7 ± 9.8 years. Of the included participants, 16 had ulcers, of whom 8 were randomly assigned to intervention. Of the remaining 79 with impending ulcers, 39 were randomly assigned to intervention. For participants with ulcers, healing rates favored tenotomy (100% vs 37.5%, P = 0.026) as did time to ulcer healing (P = 0.04). For those with impending ulcers, incidence of progression to an active ulcer was lower (1 vs 7, P = 0.028) and the number of ulcer-free days higher (P = 0.043) in the tenotomy group. No serious adverse events were recorded.

Conclusions: This randomized study showed that the simple procedure of needle flexor tendon tenotomy was effective and safe when treating and preventing ulcers associated with the diabetic hammertoe deformity
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Flexor Tenotomy for Plantar Ulcers of the Toes

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W J Liggins Well-Known Member

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Flexor Tenotomy for Plantar Ulcers of the Toes

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

W J Liggins Well-Known Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Flexor Digitorum Brevis tenotomy

Curly toe and flexor tenotomy healing in children

Variation of the flexor digitorum brevis anatomy

Flexor Digitorum Brevis Myositis or plantar fasciitis?

Increased Flexor Hallucis Longus Tension Decreases Ankle Dorsiflexion

EXTRINSIC toe flexor strength is not related to postural stability during static ...

Flexor hallucis longus tendon branch test

Share This Page

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