Percutaneous flexor tenotomy for treatment of neuropathic toe ulceration secondary to toe contracture in persons with diabetes: a systematic review.

UNLABELLED: Percutaneous flexor tenotomy has been proposed for treatment of neuropathic toe ulcerations secondary to toe contracture in persons with diabetes who have failed ongoing local wound care measures due to the perceived safety and efficacy. Because this patient population comprises a substantial proportion of the authors' practice, we undertook a systematic review of electronic databases and other relevant sources to identify material relating to the use of percutaneous flexor tenotomy for the treatment of neuropathic toe ulcerations secondary to toe contracture deformities in persons with diabetes. Information from peer-reviewed journals, as well as that from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, was considered. In an effort to procure the highest-quality studies available, studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing the same percutaneous surgical treatment, evaluated patients at a mean follow-up of > or =12 months' duration, and included details of complications. Two studies were identified that met the inclusion criteria, both of which were retrospective case series of relatively poor methodological quality. Rather than providing strong evidence for or against the use of percutaneous flexor tenotomy for the treatment of neuropathic toe ulceration secondary to toe contracture in persons with diabetes, the results of this systematic review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention. LEVEL OF EVIDENCE: 1.