Prevention of Foot Ulceration and Amputation By Decompression of Peripheral Nerves In Patients with Diabetic Neuropathy

Diabetic neuropathy occurs in a stocking and glove distribution, consistent with a systemic metabolic disease. This concept has lead to the conclusion that there is no role for surgery in this debilitating condition. The classic medical approach to the treatment of diabetic neuropathy is an attempt to achieve a euglycemic state, to obtain regular Podiatric care of the feet, to inspect the feet regularly for the presence of deformity, ulcer and infection, and to help the patient achieve pain control with neuropathic pain medications. Unfortunately, all too often this approach is not successful in relieving the patient’s pain, and the loss of sensation provides the basis for infection, ulceration and amputation. The purpose of this article is to review the basic scientific and clinic research that support the statement that "today it is possible to restore sensation and relieve pain in 80% of patients with symptoms of diabetic neuropathy by decompression of multiple peripheral nerves". Furthermore, no one who has had sensation restored with this procedure has developed an ulcer, thereby changing the natural history of diabetic neuropathy.