Comparative Outcomes of Percutaneous Needle Tenotomy Performed by a Podiatrist Versus an Orthopaedic Surgeon in the Management of Toe Ulcers

BACKGROUND: Foot ulceration is a debilitating and often disabling complication of diabetes mellitus, with negative prognostic associations in terms of morbidity and mortality. Percutaneous needle tenotomy (PNT) is increasingly recognized as a safe, minimally invasive procedure for treating tendon-related deformities, including mechanical forefoot ulceration. This study evaluated clinical outcomes of needle flexor tenotomies performed by a podiatrist versus an orthopaedic surgeon. METHODS: This service evaluation reviewed consecutive adult patients with foot ulceration who received needle tenotomy by a senior podiatrist, excluding those who underwent alternative procedures/amputation. Orthopaedic surgeon conducted tenotomy was the comparison group. RESULTS: Podiatrist: 30 patients underwent needle tenotomy (total-31 feet) (23 patients had diabetes). Orthopaedic surgeon: 10 patients underwent needle tenotomy (total-12 feet). Median age was 71.5 years (range: 39.0-92.0), with 8 males/2 females. (8 patients had diabetes). The podiatrist-led group was older and had higher HbA1c, greater proportion of smokers, larger ulcer size and longer ulcer duration pre-intervention (median 54 vs. 20 weeks and p = 0.002) than the orthopaedic surgeon-led group. Despite these differences in disease severity, time to ulcer resolution (median 4.7 vs. 2 weeks, p = 0.119) and the rate of complete healing (86.7% vs. 100% and p = 0.556) did not differ significantly between groups. CONCLUSION: The lowest cost of the minor surgical foot procedure as a day case = £554 (€662) with this cost at least halved by conducting the procedure in a podiatry clinic. In conclusion, podiatrist-led percutaneous needle tenotomy is a safe and effective intervention for foot ulcers, achieving healing outcomes comparable to an orthopaedic surgeon. We hope that the procedure can be adopted more widely.