We hypothesized that tibial nerve decompression would improve sympathetic nerve function, leading to increased blood flow, enhanced plantar sensitivity, and reduced healing time for diabetic neuropathic ulcers. This prospective study involved 20 patients with non-healing diabetic neuropathic ulcers averaging 17.1 months in duration. Patients had good glycemic control and positive Tinel sign at the tarsal tunnel, with average ulcer size of 10.49 cm². Preoperatively, sensory symptoms were assessed using the Michigan Neuropathy Screening Instrument (MNSI) and two-point discrimination test, ulcer characteristics using DMIST scale, and blood flow via Doppler ultrasonography of the posterior tibial artery. "Dellon Decompression" of the 4 medial ankle tunnels was performed. At the 9-month follow-up, MNSI scores decreased significantly from a mean of 11.85 to 5.15 (p <
0.001). Positivity of the Tinel sign, quantified using the visual analog scale, dropped from a mean of 7 to 2 (p <
0.0001). Significant improvements in sensory function of the medial, lateral plantar, and calcaneal nerves were observed (p <
0.001). Doppler ultrasonography showed blood flow in the posterior tibial artery increased from 1.72 to 2.48 cm³/s at 6 months, with further improvement at 9 months (p <
0.0001). At 9 months, 55% of patients had completely healed ulcers, with 45% showing an 83.25% reduction in ulcer size (p <
0.0001). No infections or new ulcers occurred postoperatively. In conclusion, Dellon decompression of the 4 medial ankle tunnels can enhance blood flow in diabetic neuropathy, improves wound healing in the foot's plantar area, and emphasizes the crucial role of enhanced blood flow and sensitivity in promoting foot ulcer healing in diabetic patients.