A flexor tenotomy is a useful procedure in patients with contracted digits of the foot. In this technique, we demonstrate the use of a beveled 18 gauge hypodermic needle, attached to a 3cc syringe, as a surgical instrument to perform this procedure. Sterile protocol can be executed in the operating theatre as well as in clinic scenarios. The benefits of the beveled tip offer a sharp edge to transect the tendon fibers.

We simulate this procedure with an offweight bearing examination of the digit for flexible contracture at the Metatarsophalangeal and interphalangeal joints within the toe. If reducible, and isolated to flexor contracture, this makes an excellent standalone or conjunctive corrective procedure.

The instrument is inserted perpendicular to the orientation of the nail plate or proximal interphalangeal axis. Note that the individual digits may present with frontal plane variations such as a varus rotation of the 5th digit in this example.

Controlled grip of the instrument is essential in minimizing collateral tissue damage and maintaining a small percutaneous incision. Choking up on the needle may prove useful for weak material properties or wet gloves. The landmarks for this placement is distal to the flexor digitorum brevis insertion at the base of the middle phalanx, without involving the distal interphalangeal joint structures.

Pull back off of the bone slightly and sweep medial to lateral with firm position on the digit to maintain tension on the body of the longus tendon. Your goal will be to sever the tendon against the hard bone of the middle phalanx with the sharp edge of the needle tip. Be careful not to exit skin or widen the incision when doing this. This release will often be notable in physical alleviation of the contracture, which can be felt when performing this procedure.

John D. Miller
Nicholas A. Giovinco
©2014 DrGlass.org