Name of the Procedure:

Tenotomy, open, tendon flexor; toe, single tendon
Common names: Open flexor tendon tenotomy, Single tendon toe tenotomy

Summary

An open flexor tendon tenotomy is a surgical procedure where a surgeon makes an incision to cut a specific flexor tendon in the toe. This procedure is typically performed to correct problems caused by tendon tightness or deformities.

Purpose

This procedure is used to address medical conditions like hammertoe or claw toe, which are caused by abnormal tightening or contraction of the flexor tendons. The goal is to relieve pain, correct deformities, and restore normal toe alignment and function.

Indications

• Persistent pain or discomfort in the toe
• Toe deformities such as hammertoe or claw toe
• Inability to move the toe normally due to tendon tightness
• Failure of conservative treatments such as physical therapy, orthotics, or medications

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Certain blood tests or imaging studies, like X-rays, may be required to evaluate the condition.
• Patients should inform their medical team about any medications they are taking, as some may need to be adjusted.

Procedure Description

1. The patient is typically given local anesthesia to numb the area.
2. An incision is made over the affected toe.
3. The flexor tendon is carefully located and then partially or completely cut to release the tension.
4. The incision is stitched up, and a bandage is applied.
5. The patient is monitored for a short period before being discharged.

Tools and equipment: Scalpels, sutures, bandages, and possibly specialized instruments for tendon manipulation.

Duration

The procedure typically takes about 20 to 40 minutes.

Setting

Performed in an outpatient surgical center or hospital operating room.

Personnel

• Surgeon (typically an orthopedic or podiatric surgeon)
• Surgical nurse or assistant
• Anesthesiologist or nurse anesthetist (for administering local anesthesia)

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Nerve damage leading to numbness or tingling
• Scarring
• Recurrence of the deformity
• Pain or discomfort post-procedure

Benefits

• Relief from toe pain and discomfort
• Improved toe function and alignment
• Resolution of deformities
• Enhanced mobility and quality of life

Benefits are often realized shortly after recovery, typically within a few weeks.

Recovery

• Patients should keep the surgical site clean and dry.
• Limited weight-bearing on the affected foot is advised initially.
• Patients may need to wear a special shoe or brace for a few weeks.
• Follow-up appointments are necessary to monitor healing and remove sutures.
• Physical therapy may be prescribed to regain strength and function.

Expected recovery time is about 4 to 6 weeks, during which activities may need to be modified.

Alternatives

• Non-surgical options like physical therapy, custom orthotics, or medication
• Minimally invasive procedures, although specific cases may not be suitable
• Pros: Non-surgical options have lower risk and quicker recovery.
• Cons: They may not resolve severe deformities or pain as effectively as surgery.

Patient Experience

During the procedure, the patient should only feel pressure or minimal discomfort due to local anesthesia. After the procedure, mild to moderate pain may be experienced, managed with pain medication. Some swelling and bruising are normal, with pain and discomfort typically subsiding within a week or two.