Elsevier

The Journal of Foot and Ankle Surgery

Volume 48, Issue 6, November–December 2009, Pages 684-689
The Journal of Foot and Ankle Surgery

Review Article
Percutaneous Flexor Tenotomy for Treatment of Neuropathic Toe Ulceration Secondary to Toe Contracture in Persons with Diabetes: A Systematic Review

https://doi.org/10.1053/j.jfas.2009.06.004Get rights and content

Percutaneous flexor tenotomy has been proposed for treatment of neuropathic toe ulcerations secondary to toe contracture in persons with diabetes who have failed ongoing local wound care measures due to the perceived safety and efficacy. Because this patient population comprises a substantial proportion of the authors' practice, we undertook a systematic review of electronic databases and other relevant sources to identify material relating to the use of percutaneous flexor tenotomy for the treatment of neuropathic toe ulcerations secondary to toe contracture deformities in persons with diabetes. Information from peer-reviewed journals, as well as that from non-peer–reviewed publications, abstracts and posters, textbooks, and unpublished works, was considered. In an effort to procure the highest-quality studies available, studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing the same percutaneous surgical treatment, evaluated patients at a mean follow-up of ≥12 months' duration, and included details of complications. Two studies were identified that met the inclusion criteria, both of which were retrospective case series of relatively poor methodological quality. Rather than providing strong evidence for or against the use of percutaneous flexor tenotomy for the treatment of neuropathic toe ulceration secondary to toe contracture in persons with diabetes, the results of this systematic review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention. Level of Evidence: 1

Section snippets

Materials and Methods

Eleven electronic databases, including the American College of Physicians Journal Club (http://www.acpjc.org/), Cumulative Index of Nursing and Allied Health Literature (http://www.ebscohost.com/cinahl/), Cochrane Library (http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0), Cochrane Controlled Trials Register (http://www.ovid.com/site/products/ovidguide/cctrdb.htm), Cochrane Database of Systematic Reviews (http://www.cochrane.org/reviews/), Cochrane Methodology

Results

The search for potentially eligible information for inclusion in the systematic review yielded a total of 16 references. All other references identified, both published and unpublished, were obtained and reviewed by the authors in March 2009. After considering all of the potentially eligible references, only 2 (12.5%) of the studies met all of the inclusion criteria (Table 1) 40, 43. Both studies involved percutaneous flexor tenotomy of the hallux and/or lesser toes with immediate ambulation as

Discussion

The purpose of this systematic review was to evaluate the best evidence available for performing percutaneous flexor tenotomy of the hallux and/or lesser toes for the treatment of neuropathic toe ulceration secondary to toe contracture in persons with diabetes with regard to efficacy and safety. Only 2 studies could be identified that met the inclusion criteria, neither of which were prospective in design or involved a control group 40, 43. In addition, neither of these studies corresponded to

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    Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.

    Financial Disclosure: None reported.

    Conflict of Interest: None reported.

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