Can diabetic peripheral neuropathy symptoms be reversed via surgery?

Diabetic Peripheral Neuropathy Treatment

Diabetic peripheral neuropathy (DPN) is a type of nerve damage that affects the extremities in people with diabetes. It is caused by high blood sugar levels that damage the nerves over time. The condition can affect people in different ways but is often described as: 

  • Tingling in the feet and hands
  • Intense burning
  • Severe pins and needles
  • Feeling like your feet are covered in ants
  • Feeling like you’re walking on barbed wire
  • An overall feeling of numbness that makes it hard to keep your balance

Until recently, it was felt that DPN was an incurable disease that was irreversible and would progressively worsen over time. Treatments typically focus on managing symptoms and preventing further damage. This often includes diet, exercise, and medication. We agree with aggressive control of blood sugar levels as the mainstay of trying to slow or halt the progression of symptoms. We are also thankful that there are some medications that can improve painful symptoms of neuropathy symptoms, but treatment doesn’t need to stop here. 

Over the past 15 years, there has been a growing level of evidence from different physicians and countries that surgical decompression of the affected nerves can have a profound effect on the health of the nerves badly affected by changes associated with DPN. It has been shown that diabetes causes sugar to move into the nerves itself. This sugar then can not get out and it brings water with it. Imagine how your fingers swell after eating a bunch of salty food.  How hard is it to get a ring off the finger? Why is that? Well, the finger swells but the ring around it does not change size. This is exactly what happens when the nerve swells, but the tunnel that the nerve travels through does not get bigger. The blood supply to the nerve gets cut off.  

It is not rocket science to determine what can happen next. Less blood flow equals less function.   Nerves start dying. When nerves start dying, they start talking to you to let you know it—they burn, they tingle, they send shocks, they lose feeling, and the muscles stop working.  

There are entire textbooks on all the other changes that occur in a nerve due to diabetes. Surgeons are not able to help many changes that can occur, but the work done by Dr. Dellon and others in the past 15 years has reinforced the idea that many of the symptoms that well-controlled diabetic patients complain about can improve by taking pressure off the nerves as they travel through tight tunnels in the hands and feet. Therefore, if your blood sugar is stable, nerve decompression surgery may be a part of your recommended treatment plan. 

Although surgery can’t completely reverse the nerve damage caused by DPN, it can help to alleviate pain and improve function in your feet and hands. Allowing the nerve to recover significantly can lead to improved sensation, better balance, prevention of ulcers, and less pain.   

Now these procedures are not a panacea, and they are not a “get out of jail free” card.  If a patient allows their diabetes to spiral out of control, if a patient chooses to continue to smoke after it has been recommended to stop, or if a patient fails to take their health seriously, these procedures will have a high failure rate.   

Remember, the surgery addresses one problem of the entire complex picture of DPN: we focus on the swollen nerve in the tight tunnel. We also know that the longer the nerve has been affected and the more severe the disease has been, the less likely it becomes that the surgery will work—as the nerves have just been injured too long. It is hard to bring a nerve back from the dead. However, we can help a nerve that is dying if we get there soon enough.

If you’ve been unable to enjoy your favorite activities and spend time with loved ones because of pain from diabetic peripheral neuropathy, contact our office to see if nerve decompression might be an appropriate treatment option. Since 2007, Dr. Eric H. Williams has focused his medical practice on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes, emphasizing nerve injury, entrapment, and diabetic peripheral neuropathy.  

How Does Nerve Decompression Surgery Help Diabetic Neuropathy?

Nerve decompression surgery may be used to treat the symptoms of diabetic neuropathy by relieving pressure on compressed nerves in the extremities. This pressure can be caused by a variety of factors, such as swelling of the nerve in a very tight tunnel, scar tissue, or trauma.

The goal of nerve decompression surgery is to identify and release the compressed nerve or nerves, allowing them to function normally again. This may involve making incisions in the affected area to access the nerve or nerves, followed by the removal of any sources of pressure or irritation, including tight fibrous tissue, and in some cases extra muscles. 

After nerve decompression surgery, you will likely need to limit your activity and wear a protective device or dressing to help protect the surgical site as it heals. Your surgeon may also recommend physical therapy or other rehabilitation exercises to help restore normal function to the affected nerve.

Research has shown that nerve decompression surgery can effectively reduce pain and improve sensation in people with symptoms from diabetic neuropathy, particularly in those with compression of the tibial or common peroneal and lateral femoral cutaneous nerves in the legs and the median and ulnar nerves in the legs or arms. 

However, not all cases of diabetic neuropathy can be improved with nerve decompression, and the effectiveness of nerve decompression surgery may vary depending on the individual case. 

Our Results Speak for Themselves

Our Baltimore surgical practice provides comprehensive care for those who suffer from peripheral nerve injuries, entrapments, and chronic pain or dysfunction. This includes people with nerve pain related to diabetic peripheral neuropathy. If you’d like to learn more about how we’ve helped others like you alleviate the painful symptoms of diabetic neuropathy and get back to making the most of each day, we encourage you to review our patient testimonials

For example, Dr. Williams helped a man with a history of diabetic peripheral neuropathy with entrapment of the tibial nerve at the tarsal tunnel as well as the proximal tibial nerve in the calf. The patient had diabetes for three years and struggled with numbness and pain for approximately 10 years. After nerve decompression surgery, he saw substantially reduced numbness, tingling, buzzing, and pain in his toes. Watch this testimonial video to learn more about this patient’s nerve decompression experience

Another one of our patients was similarly thrilled with her results just one week out from a tarsal tunnel release and decompression of the medial plantar, lateral plantar, and calcaneal nerves. Her previous care providers told her she had irreversible diabetic neuropathy, so she wondered if she’d simply be expected to live with numbness and pain forever. Then, after seeing Dr. Williams, she found hope for a brighter future. Even though it takes several weeks to see maximum results, she noticed substantial improvement in sensation just one week after her nerve decompression surgery. Watch this testimonial video to learn how nerve decompression helped improve her quality of life.