Comparative Outcomes of Percutaneous Needle Tenotomy Performed by a Podiatrist Versus an Orthopaedic Surgeon in the Management of Toe Ulcers

Heald, Adrian and Veluchamy Rathakrishnan, Sangeeth Priyadarshan and Blong, Jessica and Sharpe, Andrew and Gorman, Andy and Jude, Edward and Stedman, Mike and Robinson, Adam and Reeves, Neil D. and Gee, Edward and Allen, Matthew (2026) Comparative Outcomes of Percutaneous Needle Tenotomy Performed by a Podiatrist Versus an Orthopaedic Surgeon in the Management of Toe Ulcers. Journal of Foot and Ankle Research, 19 (1): e70123. ISSN 1757-1146

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Abstract

Background: Foot ulceration is a debilitating and often disabling complication of diabetes mellitus, with negative prognostic associations in terms of morbidity and mortality. Percutaneous needle tenotomy (PNT) is increasingly recognized as a safe, minimally invasive procedure for treating tendon‐related deformities, including mechanical forefoot ulceration. This study evaluated clinical outcomes of needle flexor tenotomies performed by a podiatrist versus an orthopaedic surgeon. Methods: This service evaluation reviewed consecutive adult patients with foot ulceration who received needle tenotomy by a senior podiatrist, excluding those who underwent alternative procedures/amputation. Orthopaedic surgeon conducted tenotomy was the comparison group. Results: Podiatrist: 30 patients underwent needle tenotomy (total—31 feet) (23 patients had diabetes). Orthopaedic surgeon: 10 patients underwent needle tenotomy (total—12 feet). Median age was 71.5 years (range: 39.0–92.0), with 8 males/2 females. (8 patients had diabetes). The podiatrist‐led group was older and had higher HbA1c, greater proportion of smokers, larger ulcer size and longer ulcer duration pre‐intervention (median 54 vs. 20 weeks and p = 0.002) than the orthopaedic surgeon–led group. Despite these differences in disease severity, time to ulcer resolution (median 4.7 vs. 2 weeks, p = 0.119) and the rate of complete healing (86.7% vs. 100% and p = 0.556) did not differ significantly between groups. Conclusion: The lowest cost of the minor surgical foot procedure as a day case = £554 (€662) with this cost at least halved by conducting the procedure in a podiatry clinic. In conclusion, podiatrist‐led percutaneous needle tenotomy is a safe and effective intervention for foot ulcers, achieving healing outcomes comparable to an orthopaedic surgeon. We hope that the procedure can be adopted more widely.