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

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 osteomyeutis 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.