Outcomes of Flexor Hallucis Longus Percutaneous Tenotomy for Great Toe Tip Callosity and Ulcers in Patients with Diabetes Mellitus: Cohort Study

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Aims and background: Great toe ulcers are the most common index lesion in persons with diabetic foot syndrome in 43-55.5% of patients.The most typical foot deformity in persons with diabetic peripheral neuropathy is claw toe deformity.The present study is a retrospective analysis of percutaneous flexor hallucis longus (FHL) tenotomies done on patients with diabetes, hallux claw deformities with ulcers of the hallux tip and their outcomes.Methods: A retrospective study was done to identify patients who underwent percutaneous FHL tenotomy between May 2016 and January 2022.Results: A total of 38 diabetic patients had percutaneous tenotomy of FHL.A total of 18 patients had grade 0, 12 patients had grade I, and eight patients had grade II ulcers, according to Wagner's grading.The mean time to heal for callosities and ulcers was 37 and 45 days, respectively, post tenotomy.Four patients had a recurrence of toe tip ulcer in a mean of 14 months.One patient had developed a transfer ulcer at the interphalangeal (IP) joint region.None of the patients had difficulty in gait or doing routine day-to-day activities and wearing footwear due to the loss of FHL action.Conclusion: Percutaneous tenotomy of the FHL tendon resulted in the healing of great toe tip ulcers in 94.8% of patients at a mean follow-up of 24 months.Clinical significance: Neglected great toe tip ulcers lead to gangrene and amputation of the affected toe.Timely treatment of these ulcers can prevent needless amputations.