Tenotomy, percutaneous, toe; single tendon
CPT4 code
Name of the Procedure:
Tenotomy, percutaneous, toe; single tendon
Common name(s): Tendon release, Percutaneous tenotomy
Summary
A tenotomy, percutaneous, toe procedure involves making a small incision to release tension in a tendon within the toe. This minimally invasive technique aims to improve toe function and relieve pain.
Purpose
Medical Condition:
- Toe deformities such as hammer toe, claw toe, or mallet toe
- Chronic pain due to tight or contracted tendons
Goals/Expected Outcomes:
- Alleviation of toe pain
- Improved toe mobility and alignment
- Enhanced ability to wear shoes comfortably
Indications
Symptoms/Conditions:
- Persistent toe pain unresponsive to conservative treatments
- Visible toe deformities affecting daily activities
- Difficulty in wearing proper footwear
Patient Criteria/Factors:
- Patients with flexible toe deformities
- Those who have not responded to physical therapy or orthotics
- Good overall health status
Preparation
Pre-procedure Instructions:
- Fasting 6-8 hours prior to the procedure, if general anesthesia is used
- Discuss any medications with the surgeon; some may need to be paused
Diagnostic Tests/Assessments:
- Physical examination of the toe
- X-rays or other imaging studies to assess the deformity
Procedure Description
- Anesthesia: Local anesthetic is administered to numb the toe.
- Incision: A small, precise incision is made over the affected tendon using a needle or scalpel.
- Tendon Cutting: The surgeon carefully cuts the tendon to release tension.
- Closure: The incision may be closed with a small suture or may not require stitches if very small.
Tools/Equipment:
- Fine scalpel or specialized needle
- Local anesthetic
- Sterile drapes and surgical instruments
Duration
The procedure typically takes around 15-30 minutes.
Setting
The tenotomy is usually performed in an outpatient clinic or surgical center.
Personnel
- Orthopedic surgeon or podiatrist
- Surgical nurse
- Anesthesiologist or nurse anesthetist (for anesthesia management)
Risks and Complications
Common Risks:
- Infection
- Bleeding
- Swelling
Rare Risks:
- Nerve damage
- Poor tendon healing
- Recurrence of deformity
Management: Antibiotics for infection, pain medications, follow-up care.
Benefits
- Relief from chronic toe pain
- Enhanced toe function and mobility
- Ability to wear shoes comfortably Realization of Benefits: Often within a few weeks post-procedure
Recovery
Post-procedure Care:
- Keep the toe clean and dry
- Follow instructions on weight-bearing limits and mobility
- Pain and swelling management with prescribed medications
Expected Recovery Time:
- Full recovery may take a few weeks
- Possible use of special footwear or orthotics during recovery
Follow-up:
- Regular check-ups to monitor healing and progress
Alternatives
Treatment Options:
- Physical therapy and stretching exercises
- Orthotic devices or special footwear
- Surgical alternatives like open tenotomy or tendon transfer
Pros and Cons:
- Physical therapy: Non-invasive but may be less effective
- Orthotics: Provide relief but do not correct the deformity
- Open surgery: More invasive, longer recovery but may be more comprehensive in severe cases
Patient Experience
During Procedure:
- Minimal discomfort due to local anesthetic
- Mild pressure sensation but no significant pain
Post-Procedure:
- Some soreness and swelling immediately after
- Pain management with medication as prescribed
- Gradual improvement in toe function and pain relief over the following weeks