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Flexor Tendon Tenotomy For Diabetic Toe Ulcers (Graphic Content)

Diabetic neuropathy causes toes to form into hammertoes, which is a deformity that can cause ulcers to form at the tips of the toe. When this happens, they sometimes can be treated by offloading the insole. However, these ulcers are notorious for coming back or not healing therefore requiring surgery. There are various surgical procedures offered for these ulcers depending on the severity of deformity. I will show you my favorite surgical procedure for these types of ulcers, which is a flexor tenotomy. It is a very effective and minimally invasive procedure performed under local anesthesia in the clinic. The tenotomy is performed with the sharp end of a needle, which means that there are no incisions, no stitches, and basically no recovery time needed. Patients can go back to work immediately after the procedure.

before surgery

11 days after

1 month after

Click below to see the surgery performed for the patient above.

This technique can be performed for similar ulcers on the great toe as well. It is a much larger tendon and requires more effort on the surgeon’s part but it is still an effective technique with excellent results.

Before surgery

1 week after

Healed puncture site

2 weeks after

Click below to see the surgery performed for the patient shown above.


Patients are allowed to walk immediately after the procedure. If they need to be on their feet a lot for work, then I try to schedule to do this on a Friday, and they can be back to work by Monday. The dressing is a light wrap around the operated toe, which is removed after 3-4 days. After that, the needle puncture site is healed, and wound care is only required for the ulcer if it is still there. Most patients feel fine walking on it immediately after surgery, some will feel achiness for a day or 2. Also, typically patients don't require pain medication for recovery from this procedure.

Patient testimonial 

Dr Haywan Chiu, DPM Haywan Chiu

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