Long Term Outcomes After Flexor Tendon Tenotomy of the Diabetic Foot.

Abstract

Background: Hammertoes is one if not the most common deformity that afflicts the diabetic foot and leads to increased risk of diabetic foot ulcers. Flexor tendon tenotomy treatment of the diabetic hammertoe has gained increased interest and is now recommended in international guidelines as a treatment of hammertoes to prevent diabetic foot ulcers. There is however no published data on the long term outcomes following tenotomy treatment.

Introduction: The objectives of this study was to describe the demographics and long-term outcomes following tenotomy treatment of individuals with diabetes who had flexor tendon tenotomies of hammertoes performed between 2006 and 2009.

Methods: This was an observational study of a cohort from a prior study. The study was performed at Steno Diabetes Center Copenhagen between 1st of January 2020 and 31st of June 2020. Participants from the prior study were invited to join the study, consisting of one visit where foot examination was performed by orthopedic surgeon. Information on medical history was obtained from medical records.

Results: Of the original 38 operated participants, 21 (55.3%) had died during the follow-up period, one (2.6%) had moved away, and one (2.6%) had incorrect procedure performed originally. At follow-up (mean 149.7 months (±17)), age of the remaining 15 participants (86.7% male) was 66.6 years (±11.4), diabetes duration was 32.2 years (±13.3), all had neuropathy and 14 (93.3%) had palpable foot pulses. The 15 Included participants had 22 toes tenotomized in the original study, of which five toes (22.7%) in four participants (26.7%) had recurrent hammertoe deformities. Of the 15 participants, 14 (93.3%) had incurred at least one ulcer during the observation period, and eight (53.3%) had incurred an amputation.

Conclusion: This study reports an undescribed risk of recurrence of deformities after tenotomies and supports that this population is at high risk of new ulcers, amputations, and have a high mortality rate.