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. 2008 Feb;51(1):41-4.

Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report

Eran Tamir  1 , Ann-Marie McLaren, Anirudh Gadgil, Timothy R Daniels
Affiliations
Free PMC article

Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report

Eran Tamir et al. Can J Surg. 2008 Feb.
Free PMC article

Abstract
in English, French

Objective: To retrospectively review the outcomes of percutaneous flexor tenotomies of diabetic claw toes with ulcers or pending ulcers.

Methods: We undertook a retrospective chart review between January 1999 and June 2005 to identify those patients who had undergone a percutaneous flexor tenotomy for diabetic claw toe deformities. We identified 34 toes in 14 patients. Of these, 24 toes had ulcerations at the terminal aspect and 3 had radiographic evidence of osteomyelitis of the terminal phalange. All patients had palpable pulses and good capillary refill. A percutaneous flexor tenotomy was performed on all toes in an outpatient clinic; patients with a rigid flexor contracture at the proximal interphalangeal joint underwent an osteoclaysis to correct a portion of the deformity.

Results: The average follow-up was 13 months. All patients with ulcers healed and there were no significant complications. Those without osteomyelitis healed within an average of 3 weeks and those with osteomyelitis healed within an average of 8 weeks.

Conclusion: A percutaneous flexor tenotomy with osteoclasis of the proximal interphalangeal joint performed in an outpatient clinic is a safe and effective method to off-load the tip of the toe so that that ulcer healing can occur. The presence of osteomyelitis is not a contraindication for this technique; however, an increased healing time can be expected.

Objectif: Étudier rétrospectivement les résultats de ténotomies percutanées du fléchisseur de l'orteil en griffe de diabétique avec ulcères ou ulcères imminents.

Méthodes: Nous avons entrepris une étude rétrospective de dossiers datant de janvier 1999 à juin 2005 afin d'identifier les patients qui avaient subi une ténotomie percutanée du fléchisseur à cause de difformités de l'orteil en griffe de diabétique. Nous avons trouvé 34 orteils chez 14 patients. Sur ce total, 24 orteils avaient des ulcères à la face terminale et dans trois cas, la radiographie indiquait une ostéomyélite de la phalange terminale. Tous les patients avaient un pouls palpable et un bon remplissage capillaire. On a procédé en service externe à une ténotomie percutanée du fléchisseur sur tous les orteils. Les patients qui avaient une contraction rigide du fléchisseur à l'articulation interphalangienne proximale ont subi une ostéoclasie visant à corriger une partie de la difformité.

Résultats: Le suivi moyen a été de 13 mois. Tous les patients qui avaient des ulcères ont guéri et il n'y avait plus aucune complication importante. Ceux qui n'avaient pas d'ostéomyélite ont guéri en trois semaines en moyenne et ceux qui en avaient une, en huit semaines en moyenne.

Conclusion: La ténotomie percutanée du fléchisseur avec ostéoclasie de l'articulation interphalangienne proximale pratiquée en service externe constitue une façon sûre et efficace d'éliminer la charge au bout de l'orteil afin que l'ulcère puisse guérir. La présence d'une ostéomyélite ne constitue pas une contre-indication pour cette technique, mais on peut s'attendre à ce que la guérison prenne plus de temps.

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Figures

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FIG. 1. Toe anatomy and changes with a claw toe deformity.
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FIG. 2. Left: Patient with a 15-year history of diabetes. Patient has a high arched foot with equinus contracture and clawing of the lesser toes. These subtle deformities have been precipitated by the motor neuropathy. Right: Ulceration at tip of a toe caused by a claw toe deformity.
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FIG. 3. Foot prepped and draped in the clinic. The ankle is dorsiflexed to neutral, the toe is held in extension at the metatarsophalangeal joint and flexion at the proximal interphalangeal joint to create bowstringing of the flexor tendon. This improves the surgeon's ability to isolate the tendon while performing the percutaneous flexor tenotomy.
See this image and copyright information in PMC

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