Can Diabetic Nerve Decompression Have An Impact?
- Volume 21 - Issue 3 - March 2008
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The treatment of patients with diabetes and associated complications has been extensively studied. Over the past several decades, the treatment of foot and ankle ailments in patients with diabetes has dramatically shifted from conservative measures of “do not perform surgery” to the present day thinking that has taught us that diabetic feet are not very different from normal feet.
The most common misconception with diabetic foot ailments has been that the loss of limbs is due to severe vascular problems. However, with time, we have found that vascular issues in the diabetic foot are less problematic than previously suggested and less common than suspected. Often, the ulcer formation is the result of neuropathy and a lack of sensation.
What has been of interest is that the major cause of peripheral limb loss among patients with diabetes is due to peripheral neuropathy and loss of protective sensation. In the past, the prevailing thinking on protective sensation loss in patients with diabetes was that it was irreversible, symmetrical and progressive. With time, there has been an increased interest in the surgical decompression of diabetic limbs in order to decrease pain and increase sensation. Although much controversy still exists, more and more doctors are beginning to understand the philosophy and potential for a chronic nerve compression of the diabetic limb.
During my residency, I spent a great deal of time with several hand surgeons. The surgeons performed a very large number of carpal tunnel releases in diabetic patients and never doubted the fact that carpal tunnel may be possible in a patient with diabetes. Now when I think back to the nerves, they were often flattened and swollen beyond normal levels with internal scarring. The diabetic nerves often were far larger and more swollen than the nerves of patients who did not have diabetes. I believe surgical decompression is a revolutionary treatment with excellent potential. However, it is essential to look at each case and weigh the benefits and risks of surgery versus conservative care.
In regard to surgical decompression, the largest study group to date is part of the Neuropathy Foundation of the Southwest with 200 or so surgeons, and over 2,000 cases logged to date. Overall, they have achieved, on average, an 80 percent improvement in pain and a 70 percent improvement in sensation among the study group patients with a positive Tinel sign over the involved nerve release sites. The results for pain relief and sensation restoration dip to 50 and 55 percent, respectively, in the groups with no Tinel sign noted.
What The Studies Have Revealed About The Etiology Of Diabetic Peripheral Nerve Compression