J Korean Foot Ankle Soc.  2018 Dec;22(4):151-155. 10.14193/jkfas.2018.22.4.151.

Outpatient Percutaneous Flexor Tenotomy for Diabetic Claw Toe Deformity with Ulcer

• Lee DH
• Chung JW

• KMID: 2428654
• DOI: http://doi.org/10.14193/jkfas.2018.22.4.151

Abstract

PURPOSE
Toe ulcers have been implicated as a causative factor in diabetic foot amputation. The aim of this study was to evaluate the outcomes of percutaneous needle flexor tenotomies of diabetic claw toes with ulcers or pending ulcers.
MATERIALS AND METHODS
The authors undertook a retrospective chart review between January 2014 and June 2016 to identify those patients who underwent a percutaneous needle flexor tenotomy for diabetic claw toe deformities. We evaluated 54 toes in 42 patients. Twenty-four patients were female and the mean age at the time of operation was 57 years. The mean follow-up time was 11 months. Thirty-four patients (46 toes) had tip toe ulcers or pending ulcers and 8 patients (8 toes) had dorsal pending ulcers. All patients had palpable pulses and good capillary refill.
RESULTS
Forty-three of 46 tip toe ulcers (93.5%) healed without significant complications and 8 dorsal ulcers showed no specific changes within 5 weeks. There were no recurrent ulcers at final follow-up. Four patients developed transfer lesion of the adjacent toe and needed subsequent tenotomy.
CONCLUSION
Percutaneous needle tenotomy in an outpatient clinic was an effective and safe method for treating toe ulcers in neuropathic patients to offload the tip of the toe so that ulcer healing could occur.

Keyword

Toes; Diabetic foot; Ulcer; Percutaneous tenotomy

MeSH Terms

Ambulatory Care Facilities
Amputation
Animals
Capillaries
Congenital Abnormalities*
Diabetic Foot
Female
Follow-Up Studies
Hammer Toe Syndrome*
Hoof and Claw*
Humans
Methods
Needles
Outpatients*
Retrospective Studies
Tenotomy*
Toes
Ulcer*

Figure

• 

  Figure 1. Photographs of 57-year-old female patient with 12 year history of diabetes. (A) Patient had a second tip toe ulcer with claw toe deformity. (B, C) A percutaneous needle flexor tenotomy was performed while applying forceful extension of the interphalangeal joint to inducing bowstring of the flexor tendon. (D) The dressing gauze was adhered to adjacent toes while keeping elevation of the ulcerated toe.

• 

  Figure 2. Photographs of 57-year-old female (A, B) and 61-year-old male (C, D) patients during follow-up. Patients had a second tip toe ulcer with claw toe deformity. (A, C) The wounds had dried up at one week after percutaneous flexor tenotomy. Small ulcer had healed completely (B), and the large ulcer had become smaller with formation of granulation tissue (D) at five weeks postoperatively. Note the toes had kept their straight position during follow-up.

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