Flexor Tendon Tenotomy in Diabetic Toe Ulcers: Evidence and Clinical Application
By: Klaus Kirketerp-Møller & Vilayvanh Saysoukha
Published in: Clinics in Podiatric Medicine and Surgery | January 16, 2026
One of the more elegant solutions in diabetic foot care doesn’t involve any high-tech dressings or expensive biologics. It’s a simple, minimally invasive office procedure called a flexor tendon tenotomy — and a recent review in Clinics in Podiatric Medicine and Surgery is making a strong case that more patients should be offered it.
Here’s the problem it solves: in patients with diabetic neuropathy, claw toe or hammer toe deformities put relentless pressure on the toe tip, creating neuropathic ulcers that refuse to heal. The reason they don’t heal isn’t just the diabetes — it’s the ongoing mechanical load. Offloading with boots and casts helps, but it doesn’t fix the underlying deformity.
Flexor tendon tenotomy does. By transecting the flexor digitorum longus tendon — a quick, precise procedure — the toe is allowed to straighten, removing the pressure point entirely. The results, backed by cohorts, systematic reviews, and randomized trials, are impressive: healing rates above 90%, rapid closure, and far fewer recurrences compared to conservative offloading alone. The procedure is now guideline-endorsed by the IWGDF (2023 guidelines), and complications are generally minor.
For patients who have been battling a stubborn toe-tip ulcer through rounds of dressings and offloading with limited success, this is a conversation worth having with their wound care team.
📎 Source: Kirketerp-Møller K & Saysoukha V. “Flexor Tendon Tenotomy in Diabetic Toe Ulcers: Evidence and Clinical Application.” Clinics in Podiatric Medicine and Surgery. 2026;43(2):219-224. DOI: 10.1016/j.cpm.2025.12.009
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