Abstract
Ulcers of the toes may cause a severe physical burden, especially in patients with
diabetes, in whom they occur most frequently. Several treatments have been proposed
for the underlying anatomical abnormalities, but they vary in effectiveness. We evaluated
our results in using flexor tenotomy to treat ulcers with underlying flexible clawing
of the toes. For 42 toes from 23 patients, 15 of whom were diabetic, all ulcers healed.
The mean healing time was 4 weeks (range, 1-8 weeks), the mean follow-up was 11 months
(range, 1-27 months), and one recurrence and one complication occurred. Postoperative
American Orthopaedic Foot Ankle Society Midfoot scores were available for 15 patients:
the mean was 77 (range, 43-100). The mean visual analogue scale (VAS) for patient
satisfaction increased from 3.9 points (range, 0-10 points) preoperatively to 7.7
(range, 5-10 points) postoperatively. Flexor tenotomy is a simple treatment with low
complications and recurrence rates and provides good-to-excellent functional outcomes
in treating flexible clawing of the toes and the associated ulceration.
Level of Clinical Evidence
Keywords
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References
- Quality of life of adults with unhealed and healed diabetic foot ulcers.Foot Ankle Int. 2006; 27: 274-280
- Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity.J Biomech. 2005; 38: 1918-1925
- Modified resection arthroplasty for infected non-healing ulcers with toe deformity in diabetic patients.Foot Ankle Int. 2008; 29: 493-497
- Deformities of the lesser toes—how should we describe them?.The Foot. 2006; 16: 16-18
- The pathological anatomy of claw and hammer toes.J Bone Joint Surg Am. 1989; 71: 45-49
- Anatomy and physiology of the extensor apparatus of the toes.J Bone Joint Surg Am. 1969; 51: 669-679
- Correction of hammer toe with an extended release of the metatarsophalangeal joint.J Bone Joint Surg Br. 2002; 84: 986-990
- Selective lengthening of the proximal flexor tendon in the management of acquired claw toes.J Bone Joint Surg Br. 2001; 83: 335-338
- Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in Caucasian diabetic men.Diabetes Care. 2004; 27: 1668-1673
- Plantar fat-pad displacement in neuropathic diabetic patients with toe deformity: a magnetic resonance imaging study.Diabetes Care. 2004; 27: 2376-2381
- Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic.J Rehabil Res Dev. 1989; 26: 35-44
- Keller procedure for the treatment of resistant plantar ulceration of the hallux.J Foot Ankle Surg. 2005; 44: 133-136
- Metatarsal head preservation in forefoot arthroplasty and the correction of severe claw toe deformity.Foot Ankle Surg. 2001; 7: 93-101
- Results of phalangectomy of the fifth toe for hammertoe. The Ruiz-Mora procedure.J Bone Joint Surg Am. 1976; 58: 1005-1007
- Tendon transplantation for clawing of the great toe.J Bone Joint Surg Am. 1938; 20: 57-60
- The extensor shift procedure in the correction of clawtoe deformities in children.South Med J. 1966; 59: 889-896
- The treatment of claw toes by multiple transfers of flexor into extensor tendons.J Bone Joint Surg Br. 1951; 33-B: 539-542
- Open flexor tenotomy for hammer toes and curly toes in childhood.J Bone Joint Surg Br. 1984; 66: 770-771
- Neuropathic toe ulcers treated with toe flexor tenotomies.Foot Ankle Int. 2007; 28: 1160-1164
- Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report.Can J Surg. 2008; 51: 41-44
- Diagnosis and treatment of forefoot disorders. Section 1: digital deformities.J Foot Ankle Surg. 2009; 48: 230-238
- Diabetic foot ulcers: pathogenesis and management.Am Fam Physician. 2002; 66: 1655-1662
- Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis.Clin Infect Dis. 2008; 47: 519-527
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Clinical outcome scoring of intra-articular calcaneal fractures.J Foot Ankle Surg. 2008; 47: 213-218
- Toe blood pressure. A valuable adjunct to ankle pressure measurement for assessing peripheral arterial disease.J Cardiovasc Surg (Torino). 1983; 24: 43-48
- Surgery for curly toe deformity: a double-blind, randomised, prospective trial.J Bone Joint Surg Br. 1993; 75: 662-663
- Epidemiology of diabetic foot problems and predictive factors for limb loss.J Diabetes Complications. 2008; 22: 77-82
- Recurrence and prevention of diabetic foot ulcers after total contact casting.Foot Ankle Int. 2007; 28: 64-69
- An analysis of iatrogenic complications from the total contact cast.Foot Ankle Int. 2005; 26: 903-907
Article info
Publication history
Published online: February 05, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
