Nerve Entrapment in Diabetic (DM) Peripheral Neuropathy – Surgery Helps Foot Ulcers and Charcot Foot Syndrome

Despite repeated studies demonstrating beneficial effects by Dellon and his contemporaries, resistance to idea of entrapment as being part of DM neuropathy continues. Recent studies demonstrate dramatic results from decompression.

Microsurgery. 2009;29(7):541-7.
Early stage diabetic Charcot Foot syndrome may respond to nerve decompression.
Nickerson DS, Alzheimer D, Dellon AL  abstract here

• Chatcot foot syndrome is a terrifying disease leading to “puzzling inflammatory process, characterized by bony resorption, pathologic fractures, soft tissue ligamentous failure, and destruction of foot architecture”.  Treatment is unsatisfactory and involves prolonged casting and foot joint fusions surgery.
• Above study presented “Two cases are presented where multiple lower extremity nerve decompression was performed early in the Charcot process. Resolution of clinical signs and radiographic abnormalities rapidly followed.”

This is indeed a miracle for someone otherwise destined to a life of foot pain and progressive foot destruction.

J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):111-5.
Low recurrence rate of diabetic foot ulcer after nerve decompression.
Nickerson DS

• 65 patients with diabetes and previous neuropathic ulcer
• “surgical decompressions of the peroneal and posterior tibial nerve branches at anatomical fibro-osseous tunnels”
• followup average 2 1/2 years; range 1-13 years
• “The combined linear annual risk of ipsilateral recurrence and new ulcer is 4.28%, the lowest reported in the scientific literature.”

Living one’s life with a leg ulcer is a miserable existence and this is again another semi-miracle.

I had previously wrote how there are now 16+ studies showing benefit of tarsal tunnel decompression:

Surgery For Diabetic Peripheral Neuropathy – Another Option Not Available Here

The studies do not have good control goods because it is unethical to cut a diabetic patient’s foot and do nothing. There seems to be no concern about not telling diabetics there could be a surgical option to their problem as was defined by a recent survey finding it is rarely mentioned:

Annals of Plastic Surgery: August 2009 – Volume 63 – Issue 2 – pp 217-221
Nerve Decompression Surgery as Treatment for Peripheral Diabetic Neuropathy: Literature Overview and Awareness Among Medical Professionals
Melenhorst, Wynand B. MD; Overgoor, Max L. MD; Gonera, Ed G. MD; Tellier, Michiel A. MD; Houpt, Peter MD, PhD

Any comments?