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Ulcer healing rates are 98% at 4 weeks.
42%
635/1507
It has a reoperation rate of approximately 50%.
9%
142/1507
There is no risk for ulceration elsewhere from transferred loads.
4%
61/1507
The ulcer recurrence rate is 30%.
35%
530/1507
Isolated flexor tenotomy is contraindicated for the deformity shown.
130/1507
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Claw toes frequently result in tip-of-toe ulceration. In flexible claw toe deformities, a flexor digitorum longus tenotomy has been shown to result in 98% healing rates at 4 weeks.Claw toe deformity is characterized by MTP hyperextension and resulting PIP and DIP flexion. Synovitis is the most common cause but it may also be caused by trauma or missed compartment syndrome of the deep posterior compartment of the leg. A trial of non-operative treatment consists of shoe modification and taping. Surgical management consists of either isolated flexor tenotomy or Girdlestone procedure for flexible deformities and proximal phalanx resection for fixed deformities. Weill osteotomy is indicated for claw toe deformity of all four lesser toes and can result in a floating toe.Tamir et al evaluated the outcomes of percutaneous tenotomies for diabetic foot ulcers. Of the 160 total tenotomies reported, 103 were tip-of-toe ulcers. These were treated with percutaneous flexor digitorum longus tenotomy. At 4 weeks, 98% of these ulcers had healed. There was a low complication rate, with 8% requiring a subsequent tenotomy.Scott et al performed a systematic review evaluating the previously reported outcomes of percutaneous tenotomy for ulcer healing. They identified 5 studies with a total of 250 flexor tenotomies performed. They found a 92-100% ulcer healing rate with a 0-18% recurrence rate. They warned of the possibility of transfer ulcers developing as pressure is shifted elsewhere. They conclude that higher-quality research is needed to definitively determine the efficacy and safety of percutaneous flexor tenotomies in the treatment of diabetic foot ulcers.Figure A is a clinical photograph demonstrating claw toe deformity. Illustration A is a depiction of the deformity seen in claw toes.Incorrect Answers:Answer 2: The reoperation rate has been shown to be approximately 8%.Answer 3: Transfer ulceration is a reported complication of this procedure.Answer 4: The ulcer recurrence rate has been shown to be 0-18%Answer 5: Isolated flexor tenotomy is an acceptable treatment for flexible claw toes.
2.6
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