Safety and efficacy of percutaneous toe flexor tenotomies under local anesthesia in an outpatient setting

PURPOSE: The purpose of this study was to assess of the safety and effectiveness of percutaneous toe flexor tenotomies under local anaesthesia in an outpatient setting, in terms of complications, functional outcomes, pain on VAS, and patient satisfaction. METHODS: The authors conducted a retrospective observational study of 22 patients with painful lesser toe deformities who underwent flexor tendon tenotomies between 2018 and 2021. Inclusion criteria were (i) flexible or mild rigid deformities with plantar flexion of the distal and/or proximal interphalangeal joints, (ii) pain, footwear discomfort, or cutaneous lesions, (iii) failed conservative treatment consisting of shoe modifications, silicone orthoses, podiatric treatment, and (iv) no contraindications to local anaesthesia. Before the surgery, the authors collected patient characteristics, pain on visual analogue scale (VAS), and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Intraoperatively, total operating room time, and surgical time was recorded. Postoperatively, pain on VAS, AOFAS score, patient satisfaction, duration of analgesic use, and time to return to driving were collected. RESULTS: The cohort of 22 patients, aged 75.9 ± 8.1, comprised 13 men and 9 women, and included 27 feet. Following the surgery, all patients were able to walk unaided and were discharged the same day. There were several complications, including same-day dressing changes due to bleeding (n = 3), persistent MTP hyperextension (n = 1), and reoperation for recurrent deformity which required proximo interphalangeal (PIP) arthrodesis (n = 1). The patients used analgesics for 1.3 ± 1.3 days, and were able to return to driving in 6.3 ± 9.1 days. At follow-up of 19 ± 9.9 months, 21 patients were satisfied and would undergo the procedure again (95%), and only 3 had postoperative ulcers (11%). Pain on VAS decreased from 5.0 ± 2.0 (range, 1-8) to 0.7 ± 1.5 (range, 0-6), while AOFAS improved from 43.4 ± 16.8 (range, 15-75) to 83.5 ± 19.3 (range, 15-100). CONCLUSION: Percutaneous toe flexor tenotomies under local anaesthesia in an outpatient setting can be performed safely without the need for a full operating theatre, and leads to minimal complications. Furthermore, there was a significant reduction in pain on VAS, and increase in AOFAS score, and almost all patients were satisfied and would undergo the surgery again.