Tenotomy Surgery for Diabetic Foot Ulcer

Some diabetic foot ulcers keep coming back because a tight tendon puts constant pressure on one spot of the foot. Tenotomy is a small surgical procedure that releases that tendon to take the pressure off. This video from Elegance Diabetic Foot & Ulcer Clinic (EDFC), Surat shows tenotomy surgery for diabetic foot ulcers, performed under the guidance of Dr. Ashutosh Shah.

What the Video Covers

• What tenotomy surgery is
• Why a tight tendon can cause a diabetic foot ulcer
• How the procedure is done
• How it helps the ulcer heal and stay healed

What Is Tenotomy?

Tenotomy means cutting or releasing a tendon through a very small opening in the skin. In the diabetic foot, it is used to correct a tendon that has become tight and is pulling part of the foot into a position that creates a pressure point.

Why Tight Tendons Cause Ulcers

Diabetes can weaken the small muscles of the foot. When this happens, some tendons pull harder than others and change the foot's position:

• Claw or hammer toes: A tight flexor tendon bends the toe down, so the tip of the toe presses on the ground or the top of the toe rubs against the shoe. This can cause an ulcer at the toe tip or on the knuckle.
• Tight Achilles tendon: A tight calf tendon shifts body weight onto the front of the foot, causing ulcers under the ball of the foot.

Dressings alone may not heal these ulcers, because the pressure that caused them is still there. Releasing the tendon removes the cause.

Types of Tenotomy for Diabetic Foot

• Flexor tenotomy: Releases the tendon that curls the toe down, straightening a claw or hammer toe and taking pressure off the toe tip.
• Achilles tendon lengthening: Lengthens a tight Achilles tendon to reduce pressure on the front of the foot.

Learn more about offloading and preventive surgery, deformity correction and hammer toe and claw toe.

How the Procedure Is Done

• The procedure is usually done through a tiny cut, often needing only one stitch or none.
• It is commonly done under local anaesthesia.
• It usually takes a short time, and many patients go home the same day.
• The ulcer continues to be dressed afterwards while it heals.

The exact approach depends on the patient's foot, the ulcer and their overall health, and is decided after examination.

Benefits of Tenotomy

• Removes the pressure that is causing the ulcer
• Helps ulcers that have not healed with dressings alone
• Lowers the chance of the ulcer coming back
• Minimally invasive, with a small wound and quick recovery