TY - JOUR
T1 - Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence
AU - Mens, Marieke A.
AU - van Netten, Jaap J.
AU - Busch-Westbroek, Tessa E.
AU - Bus, Sicco A.
AU - Streekstra, Geert J.
AU - Wellenberg, Ruud H. H.
AU - Maas, Mario
AU - Nieuwdorp, Max
AU - Stufkens, Sjoerd A. S.
N1 - Funding Information: Funding: M.A.M. is supported by a personal AMC‐PhD scholarship 2019. M.N. is supported by a personal ZonMw VICI grant 2020 (09150182010020). Publisher Copyright: © 2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
PY - 2021
Y1 - 2021
N2 - Objective: To assess the effect of flexor tenotomy in patients with diabetes on barefoot plantar pressure, toe joint angles and ulcer recurrence during patient follow-up. Methods: Patients with a history of ulceration on the toe apex were included. They underwent minimally invasive needle flexor tenotomy by an experienced musculoskeletal surgeon. Dynamic barefoot plantar pressure measurements and static weight-bearing radiographs were taken before and 2–4 weeks after the procedure. Results: A total of 14 patients underwent flexor tenotomy on 50 toes in 19 feet. There was a mean follow-up time of 11.4 months. No ulcer recurrence occurred during follow-up. Mean barefoot plantar pressure was assessed on 34 toes and decreased significantly after the procedure by a mean 279 kPa (95% CI: 204–353; p < 0.001). Metatarsophalangeal, proximal interphalangeal and distal interphalangeal joint angles were assessed on nine toes and all decreased significantly (by 7° [95% CI: 4–9; p < 0.001], 19° [95% CI: 11–26; p < 0.001] and 28° [95% CI: 13–44; p = 0.003], respectively). Conclusion: These observations show a beneficial effect of flexor tenotomy on biomechanical and musculoskeletal outcomes in the toes, without ulcer recurrence.
AB - Objective: To assess the effect of flexor tenotomy in patients with diabetes on barefoot plantar pressure, toe joint angles and ulcer recurrence during patient follow-up. Methods: Patients with a history of ulceration on the toe apex were included. They underwent minimally invasive needle flexor tenotomy by an experienced musculoskeletal surgeon. Dynamic barefoot plantar pressure measurements and static weight-bearing radiographs were taken before and 2–4 weeks after the procedure. Results: A total of 14 patients underwent flexor tenotomy on 50 toes in 19 feet. There was a mean follow-up time of 11.4 months. No ulcer recurrence occurred during follow-up. Mean barefoot plantar pressure was assessed on 34 toes and decreased significantly after the procedure by a mean 279 kPa (95% CI: 204–353; p < 0.001). Metatarsophalangeal, proximal interphalangeal and distal interphalangeal joint angles were assessed on nine toes and all decreased significantly (by 7° [95% CI: 4–9; p < 0.001], 19° [95% CI: 11–26; p < 0.001] and 28° [95% CI: 13–44; p = 0.003], respectively). Conclusion: These observations show a beneficial effect of flexor tenotomy on biomechanical and musculoskeletal outcomes in the toes, without ulcer recurrence.
KW - diabetes complications
KW - diabetic foot
KW - diabetic neuropathies
KW - hammer toe syndrome
KW - tenotomy
UR - http://www.scopus.com/inward/record.url?scp=85121370274&partnerID=8YFLogxK
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UR - https://www.ncbi.nlm.nih.gov/pubmed/34877692
U2 - https://doi.org/10.1111/dme.14761
DO - https://doi.org/10.1111/dme.14761
M3 - Article
C2 - 34877692
SN - 0742-3071
SP - e14761
JO - Diabetic medicine
JF - Diabetic medicine
ER -