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.

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).

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.
Original languageDanish
Publication date2020
Publication statusPublished - 2020
EventDiabetic Foot Study Group 2020, 16th meeting: One world, one DFSG, the original scientific meeting of the diabetic foot – but virtual - Virtual meeting
Duration: 18 Sept 202020 Sept 2020


ConferenceDiabetic Foot Study Group 2020, 16th meeting
LocationVirtual meeting
Internet address

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