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Flexor Tendon Tenotomy in Diabetic Toe Ulcers: Evidence and Clinical Application.
Klaus Kirketerp-Møller1, Vilayvanh Saysoukha2
1Department of Dermatology, Copenhagen Wound Healing Center, Bispebjerg Hospital, Copenhagen, Denmark; Steno Diabetes Center, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Denmark.
Clinics in Podiatric Medicine and Surgery
|March 19, 2026
Summary
Flexor tendon tenotomy (FTT) effectively treats diabetic neuropathic toe ulcers by reducing pressure and promoting healing. This minimally invasive surgery offers high healing rates and prevents recurrence, making it a recommended strategy.
Area of Science:
- Podiatry and Diabetic Foot Care
- Minimally Invasive Surgical Techniques
Background:
- Neuropathic toe-tip ulcers in diabetes often result from deformities like claw and hammer toes.
- These deformities increase distal plantar pressure, hindering ulcer healing and leading to recurrence.
Purpose of the Study:
- To evaluate the efficacy of flexor tendon tenotomy (FTT) in treating neuropathic toe-tip ulcers in diabetic patients.
- To assess FTT's role in reducing plantar pressure and preventing ulcer recurrence.
Main Methods:
- Review of evidence from cohort studies, systematic reviews, and randomized controlled trials.
- Analysis of healing rates, recurrence rates, and complication profiles associated with FTT.
Main Results:
- Flexor tendon tenotomy demonstrates healing rates exceeding 90% for diabetic neuropathic toe ulcers.
- The procedure leads to rapid ulcer closure and significantly fewer recurrences compared to conservative offloading.
- Complications are generally minor, although long-term risks persist.
Conclusions:
- Flexor tendon tenotomy is an effective treatment and preventive strategy for diabetic neuropathic toe-tip ulcers.
- It is endorsed by guidelines (IWGDF 2023) as part of multidisciplinary diabetic foot care.
- FTT offers a valuable minimally invasive option to improve outcomes in diabetic foot disease.
