While some have touted surgical decompression as a possible treatment option for diabetic sensorimotor polyneuropathy (DPN), authors of a recent Diabetes Care commentary have challenged the validity of this procedure, calling it an unproven modality based on flawed hypotheses. The authors of the commentary note that the use of surgical decompression for DPN is based on several hypotheses including: signs and symptoms being caused by multiple nerve entrapments; that such entrapments can be diagnosed solely with the Tinel sign; that surgical release of the nerves corrects DPN; and that s

Do islet cells hold promise in treating diabetes? Islet cells are groupings of hormone-secreting cells in the pancreas that are responsible for several endocrine functions including the production of insulin. Pancreatic islets contain four different types of cells including: insulin-producing beta cells, glucagon-releasing alpha cells, somatostatin-producing delta cells and cells that contain polypeptides (PP cells). Each individual islet contains approximately 1,000 of these four types of cells. In islet cell transplantation procedures, surgeons use enzymes to extract islet cells, typically

An 11-year-old boy presents to the clinic with a chief complaint of multiple bumps on his right leg and foot. He reports the lesions have been present for almost two months and appear to be increasing in number and size. The boy did not see his pediatrician or family physician for this condition. The patient says the lesions started as very small bumps and they itched but not too badly. After scratching one of the bumps, the boy says the bump got bigger and new bumps occurred around the area in a few days or so. After further questioning, the patient and his mother stated that he had no know

As the population ages, the impact of chronic disease is challenging the world of medicine. Rheumatoid arthritis (RA) is a chronic disease that affects more than 2.1 million Americans and, unlike osteoarthritis, the impact of RA typically starts much earlier in life.¹ There is a wide range of pathology in the musculoskeletal system that may occur as RA progresses and in more advanced disease, more than 85 percent of patients have foot involvement.² As RA progresses or in severe cases, deformity occurs earlier and patients struggle with disabling pain and functional limita

It would be safe to say that among foot deformities, lesser digital deformities are one of the most common and one of the most complicated problems. The etiology and mechanism of action of the deformities have been well established. In order to best fix the deformity, the surgeon must have a good knowledge of the specific anatomy as well as the intricate biomechanics within the digits. The mechanism of action for the development of hammertoes, mallet toes and clawtoes has been established in the literature. It is beyond the scope of this article to expound on the anatomy and the etiology of