Hammertoes pp 365-373 | Cite as

Percutaneous Tenotomies and Capsulotomies in Neuropathic Claw Toes

  • Rachel Baisch Kang
  • Thomas S. RoukisEmail author


Percutaneous tenotomies and capsulotomies have been proposed as safe and effective treatment for neuropathic toe ulcerations in flexible diabetic claw toes. The direct and indirect costs associated with foot ulcerations, infections, and amputations as a result of diabetes are immense. Thus, the goal is not only to heal diabetic toe ulcerations but also to prophylactically prevent ulcer development. Percutaneous tenotomies can decrease shearing forces and pressure by providing structural alignment in the flexible neuropathic claw toe.


Claw toe Hammer toe Diabetic foot Percutaneous Tenotomy Neuropathic Ulcers Prevention Diabetes Mellitus Peripheral nervous system diseases Diabetic foot Hammertoe syndrome 


  1. 1.
    Viswanathan V, Kumpatla S. Pattern and causes of amputation in diabetic patients: a multicentric study from India. J Assoc Physicians India. 2011;59:148–51.PubMedGoogle Scholar
  2. 2.
    Singh N, Armstrong D, Lipsky B. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–28.CrossRefGoogle Scholar
  3. 3.
    Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle diabetic foot study. Diabetes Care. 1999;22(7):1036–42.CrossRefGoogle Scholar
  4. 4.
    Thomas R, Brenton K, Harris B, Ham R, Rees G, Gorvett T, et al. Foot ulceration in a secondary care diabetic clinic population: a 4-year prospective study. Diabetes Res Clin Pract. 2010;90(2):e37–9.CrossRefGoogle Scholar
  5. 5.
    Myerson MS, Shereff MJ. The pathological anatomy of claw and hammertoes. J Bone Joint Surg Am. 1989;71(1):45–9.CrossRefGoogle Scholar
  6. 6.
    Tamir E, Vigler M, Avisar E, Finestone AS. Percutaneous tenotomy for the treatment of diabetic toe ulcers. Foot Ankle Int. 2014;35(1):38–43.CrossRefGoogle Scholar
  7. 7.
    Guyton GP, Saltzman CL. The diabetic foot: basic mechanisms of disease. J Bone Joint Surg Am. 2001;83(7):1084–96.CrossRefGoogle Scholar
  8. 8.
    Lipsky BA. A report from the international consensus on diagnosing and treating the infected diabetic foot. Diabet Metab Res Rev. 2004;20(Suppl 1):S68–77.CrossRefGoogle Scholar
  9. 9.
    Lipsky BA, Berendt AR, Embil J, De Lalla F. Diagnosing and treating diabetic foot infections. Diabetes Metab Res Rev. 2004;20(Suppl):S56–64.CrossRefGoogle Scholar
  10. 10.
    Zgonis T, Roukis TS. A systematic approach to diabetic foot infections. Adv Ther. 2005;22(3):244–62.CrossRefGoogle Scholar
  11. 11.
    Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, et al. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2006;45(Suppl):S2–66.Google Scholar
  12. 12.
    Andersen CA, Roukis TS. The diabetic foot. Surg Clin N Am. 2007;87(5):1149–77.CrossRefGoogle Scholar
  13. 13.
    Thomas JL, Blitch EL 4th, Chaney DM, Dinucci KA, Eickmeier K, Rubin LG, et al. Diagnosis and treatment of forefoot disorders. Section 1: digital deformities. J Foot Ankle Surg. 2009;48(2):230–8.CrossRefGoogle Scholar
  14. 14.
    Roukis TS, Markewych B. Minimal incision surgery: can it have an impact in diabetic limb salvage? Podiatry Today. 2009;22(3):37–49.Google Scholar
  15. 15.
    Roven MD. Phalangeal set. Clin Podiatr. 1985;2(3):483–9.Google Scholar
  16. 16.
    Landsman AS, Cook E, Cook J. Tenotomy and tendon transfer about the forefoot, midfoot, and hindfoot. Clin Podiatr Med Surg. 2008;25(4):547–69.CrossRefGoogle Scholar
  17. 17.
    Roven MD. Tenotomy, tenectomy and capsulotomy for the lesser toes. Clin Podiatr. 1985;2(3):471–5.Google Scholar
  18. 18.
    Roukis TS, Schade VL. Percutaneous flexor tenotomy for treatment of neuropathic toe ulceration secondary to toe contracture in persons with diabetes: a systematic review. J Foot Ankle Surg. 2009;48(6):684–9.CrossRefGoogle Scholar
  19. 19.
    Laborde JM. Treatment of forefoot ulcers with tendon lengthenings. J South Orthop Assoc. 2003;12(2):60–5.PubMedGoogle Scholar
  20. 20.
    Laborde JM. Tendon lengthenings for forefoot ulcers. Wounds. 2005;17(5):122–30.Google Scholar
  21. 21.
    Laborde JM. Neuropathic toe ulcers treated with toe flexor tenotomies. Foot Ankle Int. 2007;28(11):1160–4.CrossRefGoogle Scholar
  22. 22.
    Laborde JM. Neuropathic plantar forefoot ulcers treated with tendon lengthenings. Foot Ankle Int. 2008;29(4):378–84.CrossRefGoogle Scholar
  23. 23.
    Laborde JM. Tendon lengthening: is it a viable option for forefoot ulcers? Podiatry Today. 2005;18(7):24–34.Google Scholar
  24. 24.
    Tamir E, McLaren AM, Gadgil A, Daniels TR. Outpatient percutaneous flexor tenotomies for management of diabetic claw toe deformities with ulcers: a preliminary report. Can J Surg. 2008;51(1):41–4.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Schepers T, Berendsen HA, Oei IH, Koning J. Functional outcome and patient satisfaction after flexor tenotomy for plantar ulcers of the toes. J Foot Ankle Surg. 2010;49(2):119–22.CrossRefGoogle Scholar
  26. 26.
    Rasmussen A, Bjerre-Christensen U, Almdal TP, Holstein P. Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus. J Tissue Viability. 2013;22(3):68–73.CrossRefGoogle Scholar
  27. 27.
    van Netten JJ, Bril A, van Baal JG. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe. J Foot Ankle Res. 2013;6(1):3. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Foot and Ankle Center of Kirkland PLLCKirklandUSA
  2. 2.Orthopaedic Center, Gundersen Health SystemLa CrosseUSA

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