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Reversal of toe clawing in the patient with neuropathy by neurolysis of the distal tibial nerve.
Dellon AL, Steck JK Microsurgery. 2008 Jun 6;
The distinction between hammer toes and clawed toes is poorly emphasized. The neural origin of clawing in the foot is related to the lateral plantar nerve, and suggests that surgical treatment directed at decompression or neurolysis of the lateral plantar nerve may either reverse or prevent progression of intrinsic motor paralysis. The purpose of this report is to provide criteria to distinguish between the musculoskeletal imbalances that creates hammer versus clawing of the toes, and to demonstrate examples of improvement in clawing that resulted from neurolysis of the tibial nerve and the lateral plantar nerve.
Re: Reversal of toe clawing in the patient with neuropathy by neurolysis of the distal tibial nerve
Prevention of Ulceration, Amputation, and Reduction of Hospitalization: Outcomes of a Prospective Multicenter Trial of Tibial Neurolysis in Patients with Diabetic Neuropathy.
Dellon AL, Muse VL, Nickerson DS; et al. J Reconstr Microsurg. 2012 Mar 12.
This is the first multicenter prospective study of outcomes of tibial neurolysis in diabetics with neuropathy and chronic compression of the tibial nerve in the tarsal tunnels. A total of 38 surgeons enrolled 628 patients using the same technique for diagnosis of compression, neurolysis of four medial ankle tunnels, and objective outcomes: ulceration, amputation, and hospitalization for foot infection. Contralateral limb tibial neurolysis occurred in 211 patients for a total of 839 operated limbs. Kaplan-Meier proportional hazards were used for analysis. New ulcerations occurred in 2 (0.2%) of 782 patients with no previous ulceration history, recurrent ulcerations in 2 (3.8%) of 57 patients with a previous ulcer history, and amputations in 1 (0.2%) of 839 at risk limbs. Admission to the hospital for foot infections was 0.6%. In patients with diabetic neuropathy and chronic tibial nerve compression, neurolysis can result in prevention of ulceration and amputation, and decrease in hospitalization for foot infection.