Table 2 Literature Review – Study Characteristics
Kearney et al. [23] | Laborde [17] | Rasmussen et al. [15] | Tamir et al. [24] | Van Netten et al. [25] | |
|---|---|---|---|---|---|
Patients (No.) | 48 | 14 | 16 | 55 | 30 |
Procedures (No.) | 58 | 24 | 27 | 103 | 38 |
Age range (Years) | • Mean 68.1 ± 2.3 | • 40–81 | • 37–91 | • 48–89 | • 42-93 |
• Mean 55 | • Mean 62.8 | • Mean 65 | • Mean 69 ± 12 | ||
Gender | • M:11, F:37 | • M: 7 F: 11 | • Insufficiently reported: prophylactic and ulcerated patients reported together | • Not reported | • M: 17, F:16 |
Diabetes duration | • Not reported | • Not reported | • Insufficiently reported: prophylactic and ulcerated patients reported together | • Insufficiently reported – patients receiving different interventions reported together | • Not reported |
HbA1C | • 7.3 ± 1.4 | • Not reported | • Insufficiently reported: prophylactic and ulcerated patients reported together | • Insufficiently reported – patients receiving different interventions reported together | • Not reported |
Inclusion criteria | • Diabetes | • Not reported | • Not reported | • Not reported | • Not reported |
• Distal toe ulceration | |||||
Exclusion criteria | • Healed ulcer | • Grade 4/5 ulcersb | • Not reported | • ABPI below 0.5/flat pulse volume at ankle | • Not reported |
• Adjunct procedures | |||||
• Cellulitis | |||||
Pre-selection assessments (% of patients with condition) | • Neuropathy: mono-filament/biothesiometer (100 %) | • Neuropathy: mono-filament (100 %) | • Neuropathy: monofilament/biothesiometer (100 %) | • Neuropathy: Assessment and patient characteristics not reported. | • Neuropathy: monofilament (100 %) |
• Poor vascular status: absent pulses (14 %) | • PAD: absent pulses/Doppler (0 %) | ||||
• PAD: absent pulses (36.2 %) | |||||
• Poor arterial perfusion: Pulses/ankle blood pressure (18 %) | |||||
• Vascular status: ABPI (% not reported) | |||||
Ulcer grades –No. (% of ulcers) | • Not reported | • 1b – 11 (46 %) | • 1a – 23 (85 %) | • 0a – 25 (24 %) | • 1a – 20 (53 %) |
• 2b – 5 (21 %) | • 2a – 1 (4 %) | • 1a – 73 (71 %) | • 2a – 0 (0 %) | ||
• 3b – 8 (33 %) | • 3a – 3 (11 %) | • 2/3a – 5 (5 %) | • 3a – 18 (47 %) | ||
Ulcer duration | • Not reported | • 1 month – 5 years | • Range 1–48 weeks | • Range: 1 – 156 Weeks | • 9 – 525 days |
• Mean: 96 days | |||||
• Average: 10 months | • Median: 15 weeks | • Mean: 33 weeks | |||
Digit tenotomised | • Not specified – only FDL transected, therefore assumed to be digits 2-5 | • Hallux – 14 | • Hallux – 15 | • Hallux – 16 | • Hallux – 12 |
• 2 – 7 | • 2 – 10 | • 2 – 31 | • 2 – 15 | ||
• 3 – 2 | • 3 – 2 | • 3 – 37 | • 3 – 11 | ||
• 4 – 0 | • 4 – 0 | • 4 – 16 | • 4 – 0 | ||
• 5 – 1 | • 5 – 0 | • 5 – 3 | • 5 – 0 | ||
Incision location | Distal phalanx | Proximal portion of proximal phalanx | 1 cm proximal to the web fold | Mid-portion of proximal phalanx | Mid-portion of proximal phalanx |
Tendons transected | • FDL – 58 toes | • FDL & FDB – | • FDL & FDB – | • FDL – 87 Toes | • FDL – 26 Toes |
• 10toe | • 12 Toes | • FHL – 16 Toes | • FHL – 12 Toes | ||
• FHL – 14 Toes | • FHL & FHB – 15 Toes | ||||
Post-op offloading | • Immediate weightbearing | • Full weightbearing | • 2–3 days post-op hosp. immobilization | • Not reported | • 24 h offloading plus pressure bandage |
• Post-op shoes/sandals/extra depth shoe | |||||
• Rigid soled sandals | |||||
• Rocker bottom sandals + soft insoles | |||||
Return appointment | Not reported | 3–5 days then weekly until healed | 1 weeks then as required until healed | 1 week then regularly until healed | 1 week then regularly |
Follow-up period (months) | • Mean: 28 | • 20–64 | • 2–48 | • Minimum: 5 | • 11–60 |
• Mean: 23 ± 11 | |||||
• Interquartile range:16–29 | |||||
• Median: 22 | |||||
• Average: 36 | • Median: 31 |