Safety and effectiveness of flexor tenotomies to heal toe ulcers in persons with diabetes

Aim: To evaluate the effectiveness and safety of percutaneous tenotomy of the flexor digitorum longus to heal neuropathic ulcers on the tip of the toe. Methods: We retrospectively reviewed a cohort of 48 patients with 58 tenotomy procedures with diabetes related neuropathy and ulceration at the tip of the toe. Subjects were treated with tenotomy of the flexor digitorum longus. We then evaluated healing of the ulceration and any adverse events including recurrence, infection, healing failure, and amputation. Results: 98.3% of the ulcerations healed. Mean ulcer healing time was 40 ± 52 days 12.1% had a recurrence of ulceration at the same site. Mean time to recurrence was 13.9 months. Five percent had post-operative soft tissue infection. Two patients had amputation of the digit; both had pre-existing osteomyelitis. Mean follow up was 28 months. Conclusion: Flexor tenotomy is a safe, simple procedure, which can enhance patients' healing potential with very little risk.