Abstract
Aim:
To describe the long-term effects of flexor tenotomies, and demographics of participants with diabetes that participated in a prior study on flexor tenotomies performed by scalpel between Jan 1st, 2006 and Dec 30th, 2009 at Steno Diabetes Center Copenhagen.
Method:
An observational study of participants with diabetes, who participated in a prior study of flexor tenotomy treatment performed at our institution, were invited for a reevaluation of the operated toes and a general foot examination in our clinic. In addition, data from patient electronic health records was obtained.
Results / Discussion:
The original study included 34 participants, of these 21(61.8%) had died, and one (2.9%) was lost to follow up. The remaining 13 patients had a mean follow-up of 146 months (±31.0), 10 were male (76.9%), with a mean age of 67.2 (±24.6) years, six (46.2%) had type 1 diabetes, mean HbA1c of 60.8 mmol/L (±26.8), mean eGFR of 61.7 ml/min (Q1-Q3=42.5-87.8), mean LDL of 1.5 mmol/l (±0.96), five (38.5%) had prior or current Charcot diagnosis, nine (81.8%) had a vibration threshold above 45 V, and nine (81.8%) had missing sensation of monofilament.
At follow-up visit 18 of the initially operated toes (on 13 patients), of which six (33.3%) had reformed hammer, claw or mallet toe deformity, of these four had active flexion, and two had rigid deformities. There were active ulcers on two (11.1%) of the operated toes, and impending ulcers on further six (33.3%) toes. After the initial operation, 12 participants (92.3%) incurred a mean of 14.0 (Q1-Q3=5.0-17.5) ulcers per patient, six (46.2%) incurred one or more amputations, with a total of 10 amputations including five toe amputations, four below knee amputations (crural) and one above knee amputation (femoral).
Conclusion:
This study has shown that people with diabetes, treated with flexor tenotomies are a vulnerable population with a high mortality rate, high risk of amputation, of new ulcers and a risk of hammer, mallet and claw toes reforming over time. These facts highlight the need for close follow-up in the multidisciplinary team, and specifically a need to focus on early detection and prevention of foot complications.
To describe the long-term effects of flexor tenotomies, and demographics of participants with diabetes that participated in a prior study on flexor tenotomies performed by scalpel between Jan 1st, 2006 and Dec 30th, 2009 at Steno Diabetes Center Copenhagen.
Method:
An observational study of participants with diabetes, who participated in a prior study of flexor tenotomy treatment performed at our institution, were invited for a reevaluation of the operated toes and a general foot examination in our clinic. In addition, data from patient electronic health records was obtained.
Results / Discussion:
The original study included 34 participants, of these 21(61.8%) had died, and one (2.9%) was lost to follow up. The remaining 13 patients had a mean follow-up of 146 months (±31.0), 10 were male (76.9%), with a mean age of 67.2 (±24.6) years, six (46.2%) had type 1 diabetes, mean HbA1c of 60.8 mmol/L (±26.8), mean eGFR of 61.7 ml/min (Q1-Q3=42.5-87.8), mean LDL of 1.5 mmol/l (±0.96), five (38.5%) had prior or current Charcot diagnosis, nine (81.8%) had a vibration threshold above 45 V, and nine (81.8%) had missing sensation of monofilament.
At follow-up visit 18 of the initially operated toes (on 13 patients), of which six (33.3%) had reformed hammer, claw or mallet toe deformity, of these four had active flexion, and two had rigid deformities. There were active ulcers on two (11.1%) of the operated toes, and impending ulcers on further six (33.3%) toes. After the initial operation, 12 participants (92.3%) incurred a mean of 14.0 (Q1-Q3=5.0-17.5) ulcers per patient, six (46.2%) incurred one or more amputations, with a total of 10 amputations including five toe amputations, four below knee amputations (crural) and one above knee amputation (femoral).
Conclusion:
This study has shown that people with diabetes, treated with flexor tenotomies are a vulnerable population with a high mortality rate, high risk of amputation, of new ulcers and a risk of hammer, mallet and claw toes reforming over time. These facts highlight the need for close follow-up in the multidisciplinary team, and specifically a need to focus on early detection and prevention of foot complications.
| Originalsprog | Engelsk |
|---|---|
| Publikationsdato | 2020 |
| Status | Udgivet - 2020 |
| Begivenhed | Diabetic Foot Study Group 2020, 16th meeting: One world, one DFSG, the original scientific meeting of the diabetic foot – but virtual - Virtual meeting Varighed: 18 sep. 2020 → 20 sep. 2020 https://dfsg.org/ |
Konference
| Konference | Diabetic Foot Study Group 2020, 16th meeting |
|---|---|
| Lokation | Virtual meeting |
| Periode | 18/09/2020 → 20/09/2020 |
| Internetadresse |