Percutaneous Flexor Tenotomy Plus Plantar Capsule Release for Rigid Hammertoe: A Cadaveric Study
Bibliographic record
Abstract
Background: Rigid hammertoe deformities in diabetic patients present a therapeutic challenge: percutaneous tenotomy often fails to address capsular contractures, whereas arthrodesis carries an elevated risk of complications. We hypothesized that combining tenotomy with plantar capsule release would provide effective correction while preserving neurovascular structures. This study evaluates the feasibility correction magnitude and vascular safety of this technique through a cadaveric model. Methods: We perfused 10 clinical-grade lower-limb cadaveric specimens, possessing 14 rigid hammertoes (N = 14), with an India ink-latex mixture to highlight vascular structures. Specimens with significant pathology or prior forefoot surgeries were excluded. The angle of the hammertoe deformity was measured using a goniometer preoperatively, after percutaneous flexor tenotomy, and again after releasing the plantar capsule. Standard dissection was then conducted to assess the common plantar digital arteries. Results: Mean preoperative contracture of 56.5 (range 15-86) degrees improved to 26.8 (range 0-60) degrees (47.4%) after tenotomy of the flexor digitorum brevis and longus tendons, with 1 toe releasing fully. In cases where full release was not achieved following tenotomy, plantar capsule release was performed. Full release was obtained in 92% of the cases undergoing plantar capsule release. Importantly, no iatrogenic injury occurred to the plantar medial and lateral digital arteries during the procedure. Conclusion: In cadaveric specimens, partial release of the rigid hammertoe deformity was seen following flexor tenotomy in all but 1 toe. The addition of a proximal interphalangeal joint plantar capsule release was effective at obtaining full release, without evidence of vascular injury. As such, combining tenotomy with plantar capsule release showed effective correction in this cadaveric model and may represent a less invasive option for correcting rigid hammertoes in an outpatient setting. Level of Evidence: Level V, expert opinion includes case reports and technique tips. Clinical Relevance: This technique may offer diabetic patients a lower-risk alternative to arthrodesis, potentially reducing ulcer-related amputations through earlier intervention in outpatient settings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".