Abstract
BackgroundFlexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. The influence of infection on healing and time to heal after flexor tenotomy is unknown. Flexor tenotomy can also be used as a prophylactic treatment. The effectiveness as a prophylactic treatment has not been described before.MethodsA retrospective study was performed with the inclusion of all consecutive flexor tenotomies from one hospital between January 2005 and December 2011.ResultsFrom 38 ulcers, 35 healed (92%), with a mean time to heal of 22 ± 26 days. The longest duration for healing was found for infected ulcers that were penetrating to bone (35 days; p = .042). Cases of prophylactic flexor tenotomies (n=9) did not result in any ulcer or other complications during follow-up.ConclusionsThe results of this study suggest that flexor tenotomy may be beneficial for neuropathic diabetic foot ulcers on the distal end of the toe, with a high healing percentage and a short mean time to heal. Infected ulcers that penetrated to bone took a significantly longer time to heal. Prospective research, to confirm the results of this retrospective study, should be performed.
Highlights
Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe
A database containing all surgical procedures in the study period was scanned for the code representing flexor tenotomy, after which a list was compiled of all patients who had undergone a flexor tenotomy
Flexor tenotomy All flexor tenotomies in the study period were performed by one surgeon, following a standard protocol [7,8]
Summary
Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. Claw and hammer toe deformities frequently develop in people with diabetes, leading to increased pressure on the distal end of the toes [2]. This may lead to abundant callus and the development of ulcers. Conservative treatment of these ulcers consists of wound care, sharp debridement and off-loading of the foot by means of shoe adaptations or casting [3]. A minimally invasive surgical alternative is flexor tenotomy [4,5,6,7,8,9]. Four small retrospective studies have recently been published, describing positive results of flexor tenotomy: healing rates of 98% to 100% [6,7,8,9] after flexor tenotomy, and mean time to heal ranging from 21 to 56 days [6,7,8,9]
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