Recently I read an article that spoke about the benefits of surgical decompression as a option for patients with diabetic neuropathy. As we’ve mentioned before, diabetic neuropathy is a troublesome condition. Diabetics with the condition will suffer from nerve damage in their feet, and this can cause immense pain with each step. As the article states, some people have equated it to walking on glass.
However, diabetic neuropathy can also lead to numbness, which means you are more susceptible to injuries and cuts on your feet. Left untreated, these open wounds can lead to infections and the eventual loss of your foot.
The article discusses Dr. Timothy Best’s success treating diabetic neuropathy with nerve decompression surgery. Now, decompressing or freeing a pinched nerve will not cure the person’s neuropathy, but it may help prevent the nerve from becoming so damaged that the foot becomes numb and the person increases their risk of losing their foot.
“If we can open that channel up so the nerve has more room, the blood flow will be better and then hopefully the person has relief of their symptoms,” Best said, describing the procedure.
Decompression Study For Diabetic Neuropathy
Dr. Best conducted a small study on the outcomes of surgical decompression for patients with damaged or pinched nerves as the result of diabetic neuropathy. 22 patients underwent the operation, and their outcomes were documented over the course of a year.
“We found that the majority of people over the course of that year (of follow up) had a significant decrease in their pain,” said Best. Moreover, the relief was generally long lasting.
However, he cautioned against jumping into surgery right away. He noted that getting blood sugar levels under control should be the first step, followed by pain medications. If the patient is still suffering from pain after these two options, “then surgery is a consideration,” Best said.
He also said the operation doesn’t necessarily mean that a diabetic patient won’t need a future amputation of that foot.
“People have wondered, and I want to be clear we don’t have the answer on this, if we decompress the nerves, we decrease the pain and increase the feeling in the feet, will that lessen the chances of ultimately needing an amputation?” said Best. “We think it probably does, but I want to be very clear there’s not evidence yet to say whether it does or doesn’t We’re hopeful of course, but that’s not proven.”
Dr. Silverman Comments
Where there is confusion on this procedure is when it’s applied inappropriately. Patients, diabetic and non-diabetic, who have signs and symptoms of nerve entrapment benefit greatly when the nerve is released. The key, like with any surgery, is making the correct diagnosis.
Diabetic patients who have painful neuropathy are often just given medications as we know the natural history, and while the pain eventually goes away, oftentimes it’s followed by a numb foot, which we know leads to ulcers and amputations.
If you catch a diabetic at the right time, before the Tinel’s sign is gone, the nerve has a chance to heal and you can reverse the disease.
My favorite case was a young woman with insulin dependent diabetes who developed a foot drop from compression of her common peroneal nerve just below the knee. I was consulted on her while she lay in a hospital bed as her foot, now stuck down from contracture, had an ulcer and she needed a partial amputation for osteomyelitis, a deep bone infection. I removed the infected bone, closed the wound, released the contracted tendon and then released the nerves that were effected.
She now walks, without pain, with a normal gait. She is appreciative and she knows how happy I am to see her move that foot up and down.
It’s rare to find these cases but they are there. Doctors who haven’t seen them, well, they’ve seen you.