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

1. Anesthesia: Local anesthetic is administered to numb the toe.
2. Incision: A small, precise incision is made over the affected tendon using a needle or scalpel.
3. Tendon Cutting: The surgeon carefully cuts the tendon to release tension.
4. 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