Flexor Tenotomy and Ulcer Recurrence

Foot ulcers are a frequent problem in patients with diabetes mellitus and can lead to amputations. Prevention of these ulcers is therefore of paramount importance. Claw/hammer toe deformity is commonly seen in patients with diabetes. These deformities increase the risk of ulcer development specifically at the (apex of) the toe. Tenotomy of the tendon of the flexor muscles of the toes (tendon tenotomy) can be used to treat the consequences of claw/hammer toe deformity with the goal to prevent ulcer recurrence. For indication and assessment of outcomes of flexor tenotomy, weight-bearing CT and dynamic barefoot plantar pressure measurement can be used. This mono-center investigator blinded randomized controlled trial will compare the flexor tenotomy with usual care (including orthoses and shoe offloading). The effect on ulcer recurrence, toe joint angles, barefoot plantar pressure and quality of life will be assessed and compared between the intervention and control group.

Inclusion criteria

• A minimum age of 18 years
• Sufficient understanding of Dutch/English language
• Capable of filling out informed consent
• Peripheral polyneuropathy
• Diabetes mellitus type 1 or 2
• A minimum of one claw/hammer toe
• A documented history of diabetic ulcers underneath the toe apex in the past 5 years

Exclusion criteria

• No written informed consent
• Not meeting the inclusion criteria
• Open ulcers on the toes
• Previous participation in the study
• Pregnant women
• Concomitant participation in a study in which the patient is exposed to X-rays