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. 2022 Apr;39(4):e14761.
doi: 10.1111/dme.14761. Epub 2021 Dec 16.

Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence

Marieke A Mens  1 , Jaap J van Netten  2 , Tessa E Busch-Westbroek  2 , Sicco A Bus  2 , Geert J Streekstra  3 , Ruud H H Wellenberg  1 , Mario Maas  1 , Max Nieuwdorp  4 , Sjoerd A S Stufkens  5
Affiliations

Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence

Marieke A Mens et al. Diabet Med. 2022 Apr.

Abstract

Objective: To assess the effect of flexor tenotomy in patients with diabetes on barefoot plantar pressure, toe joint angles and ulcer recurrence during patient follow-up.

Methods: Patients with a history of ulceration on the toe apex were included. They underwent minimally invasive needle flexor tenotomy by an experienced musculoskeletal surgeon. Dynamic barefoot plantar pressure measurements and static weight-bearing radiographs were taken before and 2-4 weeks after the procedure.

Results: A total of 14 patients underwent flexor tenotomy on 50 toes in 19 feet. There was a mean follow-up time of 11.4 months. No ulcer recurrence occurred during follow-up. Mean barefoot plantar pressure was assessed on 34 toes and decreased significantly after the procedure by a mean 279 kPa (95% CI: 204-353; p < 0.001). Metatarsophalangeal, proximal interphalangeal and distal interphalangeal joint angles were assessed on nine toes and all decreased significantly (by 7° [95% CI: 4-9; p < 0.001], 19° [95% CI: 11-26; p < 0.001] and 28° [95% CI: 13-44; p = 0.003], respectively).

Conclusion: These observations show a beneficial effect of flexor tenotomy on biomechanical and musculoskeletal outcomes in the toes, without ulcer recurrence.

Keywords: diabetes complications; diabetic foot; diabetic neuropathies; hammer toe syndrome; tenotomy.

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Conflict of interest statement

None to disclose.

Figures

FIGURE 1
FIGURE 1
Barefoot plantar pressure from one step and radiograph of the right foot of a participant before and after flexor tenotomy on digitus 2, 3, 4 and 5. Barefoot plantar pressure underneath the apex of digitus 2 was 565 kPa before flexor tenotomy and 146 kPa after flexor tenotomy. DIPJ angle of digitus 2 was 49.2° before flexor tenotomy and 30.8° after flexor tenotomy
See this image and copyright information in PMC

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