Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

ABSTRACT

External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance.

Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports’ potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqued in view of recent studies using objective, measured outcome protocols which nullify such potential confounders. Pain relief is now confirmed with Level 1 studies, and Level 2 prospective information suggests protection from initial diabetic foot ulceration and most neuropathic ulcer recurrences. In view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy, this secondary compression thesis and operative treatment methodology may deserve reassessment.

KEYWORDS:

• Nerve decompression
• diabetic neuropathy and complications
• treatment of diabetic neuropathy complications
• diabetic foot ulcer prevention
• diabetic foot ulcer economics

Disclosure statement

No potential conflict of interest was reported by the author.

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D. Scott Nickerson

D. Scott Nickerson is a retired partner of Sheridan Orthopaedic Associates of Sheridan, WY. MD from The Johns Hopkins University School of Medicine of Baltimore Maryland, USA in 1977. Author of 16 peer reviewed articles on infectious disease, leprosy and diabetic neuropathy complications. Fellow American Academy of Orthopaedic Surgeons in 1982. Past board member of the Association of Extremity Nerve Surgeons.