The Effect of Percutaneous Flexor Tenotomy on Healing and Prevention of Foot Ulcers in Patients With Claw Deformity of the Toe

Schmitz, Peter P; Scheffer, Ruben; Gier, Sophie De; Król, R; Veen, Daphne van der; Smeets, Luuk

doi:10.1053/j.jfas.2019.03.004

Cited by 13 publications

(29 citation statements)

References 9 publications

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“…Potential complications of tenotomy include recurrence of ulceration, postoperative infection, and need for amputation of the toe; however, Gilheany et al reported that the complication rate was typically low after flexor tenotomy to address digital deformities [16] . Furthermore, in a series reported by Schmitz et al, ulceration recurred in 10.9% of cases, infection and bleeding developed in 4.0% and 1.0%, respectively, a second intervention was required in 1.0%, and amputation of the digit was needed in 1.0% [17] . We recommend close postoperative monitoring for these complications, although none occurred in our patient.…”

Section: Discussionmentioning

confidence: 95%

Flexor tenotomy for mallet toe with penetration of the middle phalanx head by dual-component intramedullary implant following proximal interphalangeal arthrodesis

Tonogai

2022

International Journal of Surgery Case Reports

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Introduction There is a risk of mallet toe following proximal interphalangeal (PIP) joint fusion for hammertoe. Here we describe a rare case of penetration of the dorsal aspect of the middle phalanx head by the distal portion of a dual-component intramedullary implant during progression of mallet toe that was treated with flexor tenotomy. Presentation of case A 59-year-old man underwent uneventful arthrodesis of the third PIP using a dual-component intramedullary implant and presented 6 months later with progressive mallet toe and swelling, pain, and ulceration over the distal interphalangeal joint of the third toe. Imaging showed that the distal portion of the implant had penetrated the dorsal aspect of the middle phalanx head. A longitudinal incision was made over the dorsum of the middle and proximal phalanges of the third toe and the implant was removed. A plantar incision was made at the metatarsophalangeal joint and the flexor tendon was cut to correct the mallet toe deformity. One year later, correction was satisfactory with an acceptable functional outcome and good pain relief. Discussion We successfully treated a man with penetration of the dorsal border of the middle phalanx head in the third toe by the distal portion of a dual-component intramedullary implant as a result of mallet toe that developed following PIP arthrodesis, by removing the implant and performing flexor tenotomy. Conclusion Addition of flexor tenotomy should be considered when performing PIP arthrodesis in a patient with risk factors for severe mallet toe.

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Section: Discussionmentioning

confidence: 95%

Flexor tenotomy for mallet toe with penetration of the middle phalanx head by dual-component intramedullary implant following proximal interphalangeal arthrodesis

Tonogai

2022

International Journal of Surgery Case Reports

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“…Among the included literature, ten studies were case series studies, of which seven were retrospective [17][18][19][20][21][22][23] and three prospective [24][25][26]. One randomized clinical trial was also assessed [27].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…In the study by Schmitz et al [22], 101 tenotomies to treat digital lesions in diabetic and non-diabetic patients were evaluated; those with a curative indication in 64 diabetic feet could be evaluated in isolation, but the prophylactic group with 13 diabetic feet and 4 non-diabetic feet were analyzed together. Scheepers et al [17] and Tamir et al [21] also included a minority of neuropathic patients without DM in their studies but did not specify the number of tenotomies performed in diabetic patients; therefore, they could not be assessed independently.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Effectiveness of Percutaneous Flexor Tenotomies for the Prevention and Management of Toe-Related Diabetic Foot Ulcers: A Systematic Review

Calvo-Wright

López‐Moral

García‐Álvarez

et al. 2023

JCM

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There is a high prevalence of digital deformities in diabetic patients, particularly claw toe, which can result in ulceration, often located at the tip of the toe. These lesions are challenging to off-load with conventional devices and frequently lead to infection and high amputation rates. Recent guidelines recommend considering flexor tenotomies to manage these ulcerations and prevent complications. This review, which analyzed 11 studies, aimed to assess the effect of flexor tenotomies on the healing and prevention of diabetic foot ulcers (DFUs) at the toe tip. Satisfactory results were found, with a healing rate of 92% to 100% and a mean healing time of 2–4 weeks. Few mild complications were observed, and the recurrence rate was very low. Transfer lesions were the most prevalent, but simultaneous tenotomy of all toes can eliminate this risk. Flexor tenotomies are a simple, effective, and safe procedure for the treatment and management of DFUs located at the apex of the toes and should be considered part of the standard of care for diabetic feet.

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“…The beneficial effects of flexor tenotomy in people with diabetes and claw/hammer toe deformity have been investigated in retrospective and prospective case series [ [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. Currently, one randomized controlled trial is being conducted and one was published in September 2022 [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

The efficacy of flexor tenotomy to prevent recurrent diabetic foot ulcers (DIAFLEX trial): Study protocol for a randomized controlled trial

Mens¹,

Busch-Westbroek²,

Bus³

et al. 2023

Contemporary Clinical Trials Communications

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The Effect of Percutaneous Flexor Tenotomy on Healing and Prevention of Foot Ulcers in Patients With Claw Deformity of the Toe

Cited by 13 publications

References 9 publications

Flexor tenotomy for mallet toe with penetration of the middle phalanx head by dual-component intramedullary implant following proximal interphalangeal arthrodesis

Flexor tenotomy for mallet toe with penetration of the middle phalanx head by dual-component intramedullary implant following proximal interphalangeal arthrodesis

Effectiveness of Percutaneous Flexor Tenotomies for the Prevention and Management of Toe-Related Diabetic Foot Ulcers: A Systematic Review

The efficacy of flexor tenotomy to prevent recurrent diabetic foot ulcers (DIAFLEX trial): Study protocol for a randomized controlled trial

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