What question did this study set out to answer?

This study aims to compare clinical outcomes of percutaneous needle tenotomy performed by podiatrists versus orthopaedic surgeons for foot ulcers.

February 11, 2026Open Access

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

Key Points

This study aims to compare clinical outcomes of percutaneous needle tenotomy performed by podiatrists versus orthopaedic surgeons for foot ulcers.
Evaluated adult patients with foot ulceration receiving needle tenotomy from either a podiatrist or orthopaedic surgeon.
Reviewed clinical data excluding patients who had alternative procedures or amputations.
Collected metrics on ulcer size, healing time, and patient demographics.
Median time to ulcer resolution was 4.7 weeks for the podiatrist group versus 2 weeks for the orthopaedic group, but not significantly different (p = 0.119).
The complete healing rate was 86.7% for podiatrists and 100% for orthopaedic surgeons, also not significantly different (p = 0.556).
Podiatrist group had higher HbA1c, larger ulcer sizes, and longer durations pre-intervention.

Abstract

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.

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