BACKGROUND
Flexor tenotomy of the toes to correct clawing is a common operation in foot surgery and is frequently performed by a surgeon operating alone. The technique involves manual dorsiflexion of each toe, exposure of the plantar surface, dissection to the underlying tendon and tenotomy followed by wound closure. The majority of the operation is commonly performed using one hand as the other is required to maintain the toe in dorsiflexion. It is, therefore, difficult to retract the wound edges, cut the tendon under direct vision and suture the wound.
TECHNIQUE
We have designed a ‘lead foot’ which is able to hold toes firmly in dorsiflexion, thus freeing the surgeon to operate with both hands allowing safer and quicker surgery (Fig. 1). Lead feet are simple and cheap to produce, are autoclaveable, re-usable and durable. We recommend the use of 2-mm thick roofing lead which is available from builders' merchants. The adult version is depicted (Fig. 2) but we also use a two-thirds' scale version for paediatric cases. The Nottingham lead foot is also potentially suitable for other operations on the plantar aspect of the foot and toes.
Figure 1.
Cut lead sheet showing support structures.
Figure 2.
The Nottingham lead foot in position.