Flexor Tenotomy in the Treatment of Curly Toes

Pollard, Jennifer; Morrison, P. J.

doi:10.1177/003591577506800807

Cited by 17 publications

(12 citation statements)

References 2 publications

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“…all fields were searched) in order to ensure the widest possible return of results. The earliest reference found for the use of the procedure in toe deformities in any patient population dated to 1975 [ 18 ]. All literature from this year onwards was included in the search.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review

Scott

Hendry

Locke

2016

Journal of Foot and Ankle Research

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BackgroundDiabetic toe ulcers are a potentially devastating complication of diabetes. In recent years, the percutaneous flexor tenotomy procedure for the correction of flexible claw and hammer-toe contraction deformities has been proposed as a safe and effective technique for facilitating the healing of toe-deformity related diabetic ulcers. The aim of this review is to critically appraise the evidence for the effectiveness of this surgical procedure in achieving ulcer healing, prevention of re-ulceration, and to summarise the rate of post-operative complications.MethodA search of medical databases, was performed to locate relevant literature. Titles were screened prior to abstract and full text review to identify articles relevant to the research question. Search terms included truncations of “tenotomy”, “toe”, “hallux”, “digit”, “diabetes” and “ulcer”. Peer reviewed primary research study designs specified as suitable for systematic reviews by the Centre for Reviews and Dissemination were included. Studies were excluded if they used a concurrent secondary procedure or included non-diabetic patients without reporting outcomes separately. Included studies were appraised for quality using the Methodological Index for Non-Randomised Studies tool. Levels of evidence were subsequently assigned to each outcome of interest (healing rate and prevention of re-ulceration).ResultsFrom a total search yield of 42 articles, 5 eligible studies (all case series designs) were identified for inclusion. Included studies were of low-to-moderate methodological quality when assessed using the MINORS tool. A total of 250 flexor tenotomy procedures were performed in a total of 163 patients. Included studies generally reported good healing rates (92–100 % within 2 months) post-op follow-up), relatively few recurrences (0–18 % at 22 months median post-op follow-up), and low incidences of infection or new deformity. Transfer ulcers developing on adjacent areas as a result of shifted pressure were reported by several authors.The validity of these results is undermined by methodological limitations inherent to case series designs such as a lack of control groups, non-randomised designs, as well as inconsistent reporting of post-intervention follow-up periods. There was level 4 evidence for the flexor tenotomy procedure in facilitating ulcer healing and preventing re-ulceration.ConclusionMore definitive research evidence is needed in this area to determine whether or not the flexor tenotomy is a safe and effective treatment option for people with, or at risk of developing diabetic toe ulcers. Whilst the available literature reports that the procedure may be associated with high healing rates, relatively low recurrence rates and low incidences of post-op complications, methodological limitations restrict the value of these findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0159-0) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review

Scott

Hendry

Locke

2016

Journal of Foot and Ankle Research

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“…According to Sweetnam14, congenital curly toe usually resolves spontaneously by the age of 6 years. However, if the deformity is symptomatic and conservative treatment fails, surgery is indicated1, 11, 15–17. In our cases, no baby underwent any kind of treatment.…”

Section: Discussionmentioning

confidence: 65%

Congenital curly toe of the fetus

Cho

Park

Kim

et al. 2004

Ultrasound in Obstet & Gyne

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“…In these cases, treatment, including surgical operations, may be considered. The surgical treatments usually performed are tenotomy of the long flexor tendons (Pollard & Morrison, 1975; Ross & Menelaus, 1984) or flexor–extensor tendon transfer (Biyani et al ., 1992; Hamer et al ., 1993). If the curly toe seen in the present case is causally connected with the absence of the tendon of the extensor digitorum longus muscle, the usual operative procedures may not have been effective in the treatment of the deformity, had treatment been considered.…”

Section: Discussionmentioning

confidence: 99%

A rare anomaly of the extensor digitorum longus

et al. 2004

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We encountered the absence of the tendon to the fourth toe of the extensor digitorum longus muscle of the right leg in the body of a 73-year-old Japanese woman during the course of educational dissection at Nagoya City University Medical School. The tendon to the fourth toe of the extensor digitorum longus muscle was solely absent. To our knowledge, this anatomical variation has never been cited in the medical literature. We document the precise gross anatomical findings with some morphometric measurements. Moreover, we discuss the morphology of this anomaly in relation to previously described variations and anomalies of the extensor digitorum longus muscle.

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Flexor Tenotomy in the Treatment of Curly Toes

Cited by 17 publications

References 2 publications

Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review

Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review

Congenital curly toe of the fetus

A rare anomaly of the extensor digitorum longus

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