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Lower Extremity Nerve Surgery
About the Condition
Painful neuropathy affects many millions of Americans with diabetes each year. The neuropathy is caused by changes within the nerves due to swelling and biochemical changes which lead to loss of insulation within the nerve, diminished blood supply and eventually to the death of nerve fibers and the creation of scar tissue. This process is not currently reversible. Diabetic nerves are vulnerable not only to neuropathic changes but also to nerve compression, a condition that generally is reversible. Higher incidences of carpal tunnel (compression of the median nerve at the wrist) and cubital tunnel (compression of the ulnar nerve at the elbow) in diabetics are well known compared to the non-diabetic population.
More recently, it has been recognized that diabetic patients with pain and neuropathy in the legs and feet may also suffer from nerve compression at the knee, foot and ankle, contributing significantly to their pain. This form of nerve compression is treatable with a surgical release. Significant pain relief, better sensation, balance and gait, and even lower amputation and ulceration rates in the legs which have undergone nerve decompression have been reported.
A comprehensive evaluation will be performed to screen for known compression sites of the peroneal nerve at the knee, the deep peroneal nerve in the dorsum (top) of the foot, the superficial peroneal nerve at the lower leg and ankle, and the tibial nerve in the foot and ankle. Any nerve demonstrating a Tinel’s sign (tingling to direct pressure or tapping) is likely to be undergoing compression at that point. Additional studies can be obtained including nerve conduction studies and EMG, to look at nerve health and muscle health, although distinguishing between diabetic neuropathy and nerve compression can be difficult. Additional testing with a PSSD (pressure specified sensory device) can also help to evaluate for nerve dysfunction related to nerve compression. It will also establish a baseline by which to follow nerve recovery after release.
The affected nerves in the lower leg are identified and the sites of compression are surgically released to allow for improved blood flow in the nerve and to remove the additional injury of nerve compression. A soft bandage is placed at the time of surgery. It is removed after 72 hours and the patient is allowed to bear weight after that as tolerated. Pain relief should follow shortly after surgery, when the pain from the surgical procedure subsides.