Konzept der Plantarisierung zur Zehenkorrektur beim diabetischen Fußsyndrom

Abstract

In 138 patients with diabetic foot syndrome with polyneuropathy, of which 90 were men (65.2 %) and 48 were women (34.8 %) with a median age of 65.1 years, a total of 291 toe operations with tenotomy of the FHL- or FDL-tendon were performed. Patients were either acutely affected by apical toe lesions (92.1 %) or showed an increased risk of ulcer formation (7.9 %). The median time to closing of the wound was 13 days. It was longer with higher Wagner stages. Of the surgically treated toes 3.1 % were affected by nosocomial infections. At the 1‑year follow-up 92.4 % of the patients did not show pathological results of the operated toe. Recurrence of the DFS occurred mostly during the first 6 months postoperatively. In the first year postoperatively 68.1 % of the patients remained in remission. Of the toes with Wagner grade 0, 93.7 % were free of local recurrence during the entire monitoring period and 72.2 % of the operated toes with Wagner grade 3. Within the first 1.5-8.5 months 13 % of the patients were affected by transfer lesions.

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

“…Sustained healing One RCT, 36 with 13 non-controlled studies 50,51,[135][136][137][138][139][140][141][142][143][144][145] reporting similar sustained healing rates, found tenotomy with removable ankle-high devices versus devices alone likely causes large increases in sustained healing (RR 2.52, 0.70-9.01; p = 0.16;…”

“…Seven RCTs 18,36,37,63,75,78,83 and 3 other controlled studies 89,95,96 reported baseline plantar digital DFU characteristics, with only two 63,89 95,96 reported outcomes in plantar digital DFU, while 25 non-controlled studies 50,51,98,99,101,103,104,106,107,111,[127][128][129][135][136][137][138][139][140][141][142][143][144][145]170 added relevant evidence. Note, all joint arthroplasty 95,96,[127][128][129] and digital flexor tenotomy studies 36,50,51,[135][136]…”

“…See the Comparison 7 SoF tables and forest plots in Supplementary File S2. Note as there was controlled study evidence for six different surgical offloading interventions, we reviewed each separately and produced six SoF tables for this comparison, including Achilles tendon lengthening 81,82,[114][115][116][117][118] (Comparison 7A), metatarsal head resections 34,83,91,93,94,[119][120][121][122][123][124][125] (Comparison 7B), joint arthroplasties 95,96,[126][127][128][129] (Comparison 7C), joint arthrodeses 80 (Comparison 7D), metatarsal osteotomies 92,[130][131][132][133][134] (Comparison 7E), and digital flexor tenotomies 36,50,51,[135][136][137][138][139][140][141][142][143][144][145] (Comparison 7F...…”

“…New (transfer) lesions One RCT, 36 and 10 non-controlled studies 50,51,136,137,[140][141][142][143][144][145] reporting higher (0%-24%) new transfer lesion rates than the zero events in the RCT, found tenotomy with removable ankle-high devices versus devices alone may cause small increases in new transfer lesions (RR NA; N = 1; n = 16;…”

Das diabetische Fußsyndrom besser verstehen, behandeln und vermeiden

“…Ein eindrückliches Beispiel ist die perkutane Tenotomie der langen Beugesehne der Zehen bei apikalen Läsionen der Zehenkuppen im Rahmen flexibler Krallenzehen. Die Tenotomie ist eine gut untersuchte, effektive, einfache und unkomplizierte zu handhabende Maßnahme, die das Problem in der Regel dauerhaft behebt [22] (▶ Abb. 9; s. a.…”