Safety and Feasibility of Percutaneous Flexor Digitorum Longus Needle Tenotomy: A Cadaveric Study Across Surgeon Experience Level

Abstract Background Percutaneous flexor tenotomy is used to correct lesser toe deformities but is frequently performed without direct visualization. This study evaluated the anatomic safety and feasibility of percutaneous flexor digitorum longus needle tenotomy and assessed whether performance and practicability varied by surgeon experience. Study Design Cadaveric study. Methods Fifty-four toes (digits 2–4) from nine cadaveric specimens underwent standardized percutaneous tenotomy using an 18-gauge needle performed by a podiatric attending, a third-year chief resident, and a first-year resident (18 toes per operator). Post-procedural dissections were performed to assess neurovascular integrity and tendon transection. Tendon widths were measured to calculate absolute and proportional resection. Analysis of covariance compared tendon resection depth across training levels while adjusting for original tendon width. Logistic regression estimated odds of complete transection. Results All procedures preserved the plantar digital arteries and nerves. Complete tendon transection occurred in 10 of 54 cases (18.5%): 3 attending (16.7%), 3 chief resident (16.7%), and 4 PGY1 (22.2%). Complete misses occurred in 7 attending (38.9%), 3 chief resident (16.7%), and 5 PGY1 (27.8%) cases. Mean tendon resection measured 1.56 ± 1.42 mm for the attending, 2.78 ± 1.80 mm for the chief resident, and 2.61 ± 2.15 mm for the PGY1. Conclusion Percutaneous flexor digitorum longus tenotomy with an 18-gauge needle demonstrated consistent anatomic safety across experience levels but infrequently achieved complete tendon transection. These findings suggest that complete transections may be difficult to consistently achieve percutaneously and may not be required for clinical correction. Level of Clinical Evidence 5