Flexor Tendon Tenotomy in Diabetic Toe Ulcers: Evidence and Clinical Application.

Abstract

Flexor tendon tenotomy (FTT) is a minimally invasive surgical procedure for neuropathic toe-tip ulcers in diabetes, caused by claw and hammer toe deformities. By transecting the flexor digitorum longus tendon, FTT reduces distal plantar pressure, promotes healing, and prevents recurrence. Evidence from cohorts, systematic reviews, and randomized trials shows healing rates greater than 90% with rapid closure and fewer recurrences than conservative offloading. Complications are minor, though long-term risks of new ulcers and amputations remain. FTT is guideline-endorsed (IWGDF 2023) as an effective treatment and preventive strategy within multidisciplinary diabetic foot care.