Percutaneous needle flexor tendon tenotomy to prevent diabetic foot ulcers

People with diabetes and polyneuropathy often develop foot deformities, resulting in ulcers or pre-ulcerative lesions on the apex of the toes. The Dutch guideline on diabetic foot disease recommends considering a flexor tendon tenotomy to treat a distal toe ulcer, if conservative treatment fails, and to prevent a toe ulcer if a pre-ulcerative lesion is present. To our knowledge, this technique is rarely performed in the Netherlands and if used, performed with a scalpel. Recent studies show that a new, less invasive technique, the needle flexor tenotomy, is relatively safe and effective. The purpose of this procedure is reducing mechanical pressure. However, this has not yet been quantitatively demonstrated. We regularly apply this new surgical technique, including functional assessment by means of dynamic barefoot pressure measurements. We bring this surgical technique and its biomechanical effect to your attention in this article, as an effective and easy to implement intervention.