Flexor tenotomy is a minor procedure used to treat and help prevent ulcers on the tips of the toes, particularly in people with diabetes. It can also be used as a method to treat hammer toes that are flexible. It is most often recommended when a curled or contracted toe creates too much pressure against the ground or inside a shoe.
As the tendons that bend the toes become tight, the toes may curl downward into a hammertoe or claw toe position. This creates constant pressure and friction at the tip of the toe. Over time, the skin can develop a callus, break down, and form an ulcer.
If left untreated, a diabetic foot ulcer can become infected and may spread to the underlying bone. Flexor tenotomy releases the tight tendon, allowing the toe to straighten and reducing pressure on the affected area.
Symptoms and Causes
Patients who may benefit from flexor tenotomy often have a curled toe, a thick callus, or an open wound at the tip of the toe. Ulcers may be slow to heal or keep returning despite wound care and changes in footwear.
Because diabetic neuropathy can reduce sensation, some patients have little or no pain even when an ulcer is present. This makes regular foot checks especially important.
Diagnosis and Evaluation
Your doctor will examine the toe, look for areas of skin breakdown, and assess how flexible the toe is. The location and depth of an ulcer are important in deciding whether flexor tenotomy is appropriate.
X-rays may be taken if there is concern about infection involving the bone, called osteomyelitis. Your doctor may also evaluate circulation to make sure there is enough blood flow for the wound to heal.
The procedure is generally most useful for ulcers caused by pressure from a flexible toe deformity. A rigid deformity, poor circulation, or a deeper infection may require a different or additional treatment approach.
Non-Surgical Treatment
Treatment usually begins with reducing pressure on the ulcer and caring for the wound. This may include special footwear, custom orthotics, protective padding, regular wound cleaning and debridement, and dressings.
If an infection is present, antibiotics may be needed. Managing blood sugar is also important because uncontrolled diabetes can interfere with wound healing.
If the ulcer does not heal or continues to return because of the toe deformity, your doctor may recommend flexor tenotomy.
Flexor Tenotomy Surgery
Flexor tenotomy is a minimally invasive procedure that is usually performed with local anesthesia in an outpatient setting.
A very small incision or needle puncture is made on the underside of the toe. The surgeon identifies and releases the tight tendon responsible for pulling the toe downward. Once the tendon is released, the toe can move into a straighter position, reducing pressure at its tip.
The procedure generally takes about 10 to 15 minutes per toe. Stitches are often not necessary, and patients can usually go home shortly afterward.
The procedure may be performed on more than one toe when several toes are contributing to pressure or ulcer formation. Your surgeon will determine which toes need treatment.
Recovery After Surgery
Recovery is generally straightforward. A small dressing is placed over the treatment area, and many patients can walk immediately in a postoperative sandal or protective shoe.
The procedure site usually heals within a few days, although the original ulcer may take longer to close. Many toe ulcers heal within two to four weeks, depending on their depth, circulation, blood sugar control, and overall health.
Follow-up visits are important to make sure the ulcer is healing and that pressure has not shifted to another toe. You may need continued wound care and protective footwear during recovery.
Risks and Possible Complications
Flexor tenotomy is generally a low-risk procedure, but complications can occur. These include minor infection, soreness, stiffness, or delayed healing.
One possible complication is a transfer lesion. This happens when pressure shifts to a neighboring toe after the tendon is released, potentially creating a new callus or ulcer. Your doctor will monitor the surrounding toes and determine whether more than one tendon needs to be released.
Long-Term Outlook and Prevention
By correcting the toe position and reducing pressure, flexor tenotomy can help an existing ulcer heal and lower the chance of another ulcer developing in the same area. However, ongoing diabetic foot care remains essential.
Check your feet every day for redness, calluses, cuts, or open wounds. Wear properly fitted diabetic footwear and inserts, avoid shoes that rub against your toes, and keep your blood sugar under control. Regular visits with a foot specialist can help identify problems before they become serious.
When to See a Specialist
Contact a foot specialist if you notice a recurring callus, an open sore, or a toe that curls and rubs against your shoe. Any wound that is not healing needs prompt evaluation, even if it is not painful.
If you notice increasing redness, swelling, drainage, a foul odor, or fever, seek urgent medical attention. These may be signs of infection and should not be ignored.
Insurance and Cost
We work with Medicare, most major commercial insurance carriers, including Aetna, Anthem BCBS, Cigna, Empire BCBS, and UnitedHealthcare, as well as most workers’ compensation and no-fault insurance carriers. Coverage for flexor tenotomy depends on your specific insurance plan and medical necessity requirements.
Call our billing team at (631) 981-2663 before scheduling to verify your coverage and discuss any expected out-of-pocket costs.
For a full list of accepted insurance plans, visit our Insurance Information page.
The content on this page has been authored, edited, or approved by the doctors below, and was last reviewed for accuracy on November 12, 2026.
