title: Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report.
abstract: 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 osteomyelitis healed within an average of 3 weeks and those with osteomyelitis healed within an average of 8 weeks.
  
  
  CONCLUSIONS
  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.
authors.affiliation: High Risk Foot Clinic, Maccabi Health Services, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Tamir
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: McLaren
authors.forename: Anirudh
authors.initials: A
authors.lastname: Gadgil
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Daniels
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D037801:Hammer Toe Syndrome / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000601:surgery; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D014033:Toe Joint / Q000601:surgery; D016896:Treatment Outcome