title: [Concept of plantarization for toe correction in diabetic foot syndrome].
abstract: OBJECTIVE
  Elimination of plantarization of the tip of the toe and torsion of digit 1 (D1) or D5 using percutaneous tenotomy of the flexor hallucis longus (FHL) - or the flexor digitorum longus (FDL) muscle.
  
  
  METHODS
  Flexible, in some cases also fixated hyperflexion misalignment and torsion misalignment of the distal phalanx of the toe with plantarization of physiologically non-loaded bearing parts of the toes in patients with diabetic foot syndrome (neuropathy).
  
  
  METHODS
  Critical limb ischemia.
  
  
  METHODS
  Percutaneous tenotomy of the FHL or FDL tendons using the minimally invasive lancet technique without the use of a tourniquet while the tendon is flexed by causing hyperextension of the distal phalanx and simultaneous extension of the distal interphalangeal (DIP) or interphalangeal (IP) joints.
  
  
  METHODS
  Immediate full weight-bearing mobilization in sufficiently wide protective footwear with customized cushioning or a diabetes-adapted foot bed, follow-up in initially frequent intervals (2-4 per week) in order to track the development of the transfer lesions. In the case of existing wounds, more frequent visits and relief of the wounds using a post-operative shoe are required. No thrombosis prevention with full weight-bearing is necessary.
  
  
  RESULTS
  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.
authors.affiliation: Sektion Wundchirurgie, Klinik für Diabetologie und Endokrinologie, St. Vinzenz Hospital, Chirurgische Praxis am Bayenthalgürtel, Bayenthalgürtel 45, 50968, Köln, Deutschland. engels.chirurgie@t-online.de.
authors.forename: G
authors.initials: G
authors.lastname: Engels
authors.affiliation: Orthopaedicum Nordheim-Göttingen, Göttingen, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Stinus
authors.affiliation: Zentrum für Diabetologie, Endoskopie und Wundheilung, Köln, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Hochlenert
authors.affiliation: Vitos Klinik für Neurologie, Weilmünster, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Klein
mesh_terms: D000368:Aged; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005530:Foot Deformities / Q000175:diagnosis / Q000601:surgery*; D006214:Hallux / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Foot; Minimally invasive surgery; Neuropathy; Tenotomy; Tip toe lesion