Sana Ali
The James Cook University Hospital, UKPresentation Title:
Post-tenotomy healing of ulcers and complications
Abstract
BACKGROUND: One of the most common complications of diabetes is diabetic foot ulceration (DFU). The development of DFU is multifactorial, associated with peripheral neuropathy and foot deformity. The MTP hyperextension leads to unopposed flexion of DIP and PIP by FDL, stabilization action is lost which results in foot deformity. Off-loading and debridement are the mainstay of treatment. Flexor tenotomies can be considered when a toe deformity is a risk factor for developing a toe ulcer.
METHODS: A retrospective study was performed to analyze all patients treated with flexor tenotomy for apical toe ulcers from September 2018 to September 2025 in the diabetes foot clinic at The James Cook University Hospital. From a case note review, the effect of flexor tenotomy on the healing time of ulcers and its complications was determined.
Flexor tenotomy was conducted in an outpatient setting by a single operator using a #15 scalpel for a single plantar incision to release the flexor digitorum longus tendon. No local anaesthetic or suturing was used.
RESULTS: A total of 29 lesser toe flexor tenotomies were performed on 20 patients (16 males, mean age 67) with diabetic neuropathic apical toe ulcers. The mean healing time was 28 days, with 13 ulcers (65%) healing without infection in that timeframe. Healing durations ranged from 5 to 182 days. There were 2 post-procedure infections (7%). Seven patients (35%) had toe osteomyelitis; 6 had active osteomyelitis and required antibiotics, with 4 healing in under 28 days. One patient with inactive osteomyelitis healed in 14 days without antibiotics.
CONCLUSION: Our study has shown the efficacy, safety and effectiveness of flexor tenotomy for neuropathic apical toe ulceration. The presence of active osteomyelitis can cause delayed healing. This minimally invasive, outpatient procedure shows a high healing rate with short healing time and few complications.
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