Objective To assess the effectiveness of enhanced tibial transverse transport （TTT） in conjunction with vacuum-assisted closure （VAC） therapy for managing recalcitrant diabetic foot ulcers. Methods A retrospective analysis was conducted on data from diabetic foot patients with Wagner grade ≥2 who were treated at Beijing Chaoyang Hospital and Beijing Chaoyang Hospital of Integrated Traditional Chinese and Western Medicine between July 2020 and December 2022. The patients were categorized into three groups based on their treatment regimen： VSD treatment （VSD group）， modified TTT treatment （TTT group）， and combined application of TTT and VSD （combined group）. A one-year follow-up was performed to assess general data， ulcer area before and three months after surgery， ankle brachial index， visual analog pain score， as well as adverse events within one year post-surgery among the three groups. Results The VSD group consisted of 43 patients， while the TTT group consisted of 43 patients， and the combined group consisted of 42 patients. There were no statistically significant differences in baseline characteristics among the three groups （P > 0.05）. Patients in the VSD group had longer ulcer healing time， higher pain scores， lower ankle brachial index （P < 0.05）， larger ulcer area （P = 0.029）， and higher one-year ulcer recurrence rate compared to those in the TTT group. On the other hand， patients in the combined group had shorter ulcer healing time compared to those in the TTT group （P = 0.046）. However， there were no significant differences observed between these two groups regarding ulcer area （P = 0.362）， pain scores （P = 0.932）， ankle brachial index （P = 0.671）， and one-year ulcer recurrence rate （P = 0.710）. Conclusions The efficacy of modified TTT surpasses that of VSD in promoting ulcer healing， alleviating pain， and enhancing lower limb circulation. Furthermore， the combination of VSD with modified TTT demonstrates a potential to further expedite wound healing time.