The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
May 4, 2026 · via Europe PMC
Safety and feasibility of percutaneous flexor digitorum longus needle tenotomy: A cadaveric study across surgeon experience level.
Henson-Vendrell A, Niewohner D, Bush H, LeSavage L, Bullock G, Medda AW, Gangopadhyay P.
AI summary — for doctors, generated from the abstract only
A cadaveric study found that percutaneous needle tenotomy for toe deformities safely avoided nerve and blood vessel injury regardless of surgeon experience level, but frequently failed to completely cut the targeted tendon, suggesting complete transection may not be necessary for clinical benefit.
What was studied
A cadaveric study using 54 toes from 9 specimens, in which a podiatric attending physician, a third-year chief resident, and a first-year resident each performed standardized percutaneous flexor digitorum longus needle tenotomy (18 toes per operator) using an 18-gauge needle, with post-procedural dissection to assess nerve/blood vessel preservation and the completeness of tendon cutting across experience levels.
Key findings
- All procedures across all three experience levels preserved the plantar digital arteries and nerves (no vascular or nerve injury).
- Complete tendon transection occurred in only 10 of 54 cases overall (18.5%), with similar rates across experience levels (16.7% for both attending and chief resident, 22.2% for the first-year resident).
- Complete misses (failure to cut any meaningful amount of tendon) occurred in 38.9% of attending cases, 16.7% of chief resident cases, and 27.8% of first-year resident cases.
- Mean tendon resection depth was smallest for the attending (1.56mm) and larger for the chief resident (2.78mm) and first-year resident (2.61mm).
Clinical relevance
The findings suggest that percutaneous needle tenotomy for toe deformities is anatomically safe regardless of surgeon training level, but that achieving complete tendon transection is inconsistent even among experienced practitioners, which the authors suggest may not actually be necessary for successful clinical outcomes, offering reassurance about the technique's safety profile.
Who should care
Limitations
This is a cadaveric (not live patient) study, so it cannot directly assess clinical healing or functional outcomes; the small per-operator sample size (18 toes each) limits precision of the experience-level comparisons, and cadaveric tissue properties may differ somewhat from living tissue.
Percutaneous needle tenotomy for toe deformities was anatomically safe across all surgeon experience levels in cadavers, though complete tendon cutting was achieved in less than 20% of cases regardless of experience.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Percutaneous flexor tenotomy is used to correct lesser toe deformities but is frequently performed without direct visualization. This study evaluated the anatomic safety and feasibility of percutaneous flexor digitorum longus needle tenotomy and assessed whether performance and practicability varied by surgeon experience.
Study design
Cadaveric study.
Methods
Fifty-four toes (digits 2-4) from nine cadaveric specimens underwent standardized percutaneous tenotomy using an 18-gauge needle performed by a podiatric attending, a third-year chief resident, and a first-year resident (18 toes per operator). Post-procedural dissections were performed to assess neurovascular integrity and tendon transection. Tendon widths were measured to calculate absolute and proportional resection. Analysis of covariance compared tendon resection depth across training levels while adjusting for original tendon width. Logistic regression estimated odds of complete transection.
Results
All procedures preserved the plantar digital arteries and nerves. Complete tendon transection occurred in 10 of 54 cases (18.5%): 3 attending (16.7%), 3 chief resident (16.7%), and 4 PGY1 (22.2%). Complete misses occurred in 7 attending (38.9%), 3 chief resident (16.7%), and 5 PGY1 (27.8%) cases. Mean tendon resection measured 1.56 ± 1.42 mm for the attending, 2.78 ± 1.80 mm for the chief resident, and 2.61 ± 2.15 mm for the PGY1.
Conclusion
Percutaneous flexor digitorum longus tenotomy with an 18-gauge needle demonstrated consistent anatomic safety across experience levels but infrequently achieved complete tendon transection. These findings suggest that complete transections may be difficult to consistently achieve percutaneously and may not be required for clinical correction.
DOI
10.1053/j.jfas.2026.05.002
PMID
42092726
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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