A recently released study has captured attention in medical circles for demonstrating how nerve decompression surgery can heal chronic diabetic foot ulcers that traditional treatments cannot touch. While these results offer hope to patients with existing wounds, Dr. Eric H. Williams sees an even more important message in this research: we should be treating diabetic patients before ulcers ever develop.
The study, published in the Journal of Plastic, Reconstructive & Aesthetic Surgery in January 2025, followed 20 diabetic patients with foot ulcers that had persisted for an average of 17.1 months. Through Dellon nerve decompression surgery, 55% achieved complete healing, while the remaining patients saw their wounds shrink by 83.25%. These results are undeniably impressive, but they represent treatment after significant tissue damage had already occurred.
Dr. Williams believes this research actually makes the strongest case for earlier intervention. If nerve decompression in patients with diabetic neuropathy can heal chronic wounds that have failed all other treatments, imagine what it could accomplish for well-controlled diabetic patients who haven't yet developed ulcers. The goal should be prevention, not just treatment of established complications.
Understanding What the Research Really Shows Us
The study's most significant finding may not be the ulcer healing rates, impressive as they are. The research documented how nerve decompression surgery restored blood flow and sensation in ways that could have prevented ulcers from forming in the first place.
Using Doppler ultrasound, researchers found that blood flow in the posterior tibial artery more than doubled by six months after surgery, then doubled again by nine months. This progressive improvement in circulation represents exactly what diabetic patients need to maintain healthy feet and avoid complications. To put this in perspective, blood flow increased from an average of 1.72 cm³/s before surgery to 2.48 cm³/s at six months, then jumped dramatically to 5.34 cm³/s by nine months. This isn't just statistical improvement—it represents a fundamental restoration of the circulatory function that keeps foot tissues healthy and capable of fighting off infection.
The mechanism behind this improvement relates directly to how nerve compression affects blood vessel control. When the tibial nerve becomes compressed, it doesn't just affect sensation—it also impacts the sympathetic nerve fibers that regulate blood vessel constriction and dilation. These compressed sympathetic fibers can cause blood vessels to remain unnecessarily constricted, starving foot tissues of the oxygen and nutrients they need. By releasing this compression, surgery allows blood vessels to function normally again, explaining the dramatic and progressive improvements researchers documented.
Sensation improvements were equally dramatic and arguably more important for prevention. Patients experienced significant reductions in neuropathy symptoms and nerve compression signs throughout the follow-up period. The restoration of protective sensation helps patients feel pressure points, minor injuries, and temperature changes that would normally prompt protective behaviors. Specifically, the study measured sensation using the two-point discrimination test, which assesses how well patients can distinguish between two separate points of contact on their skin. Improvements in this test indicate that patients regained their ability to detect the subtle pressure changes that occur when shoes don't fit properly, when small stones get lodged in footwear, or when calluses begin forming.
The researchers also documented improvements using the Michigan Neuropathy Screening Instrument, with scores dropping from an average of 11.85 before surgery to just 5.15 at nine months. This represents a shift from moderate-to-severe neuropathy symptoms to mild symptoms that don't significantly interfere with daily activities. Patients reported being able to feel their feet again when walking, notice when their shoes were too tight, and detect minor cuts or scrapes that previously would have gone unnoticed until they became infected.
Pain reduction provided another crucial piece of the prevention puzzle. The intensity of nerve compression symptoms, measured using the Tinel sign test, dropped from an average pain level of 7 out of 10 to just 2 out of 10. This dramatic pain relief wasn't just about comfort—it enabled patients to walk more normally, wear appropriate footwear, and engage in the kind of regular foot care that prevents problems from developing. When patients aren't constantly battling severe nerve pain, they can focus on protective behaviors like daily foot inspections and proper hygiene.
Perhaps most telling, no patients in the study developed new ulcers during the nine-month follow-up period. This finding suggests that restored nerve function and improved blood flow create an environment where wounds are unlikely to form. Dr. Williams sees this as the most important outcome because it points toward prevention rather than treatment of existing damage.
Consider what this means: these were patients who had already demonstrated their vulnerability to diabetic foot complications by developing chronic ulcers that persisted for nearly a year and a half. Yet once their nerve compression was addressed, they didn't develop any new wounds despite their high-risk status.
Why Dr. Williams Wants to See You Before You Develop Diabetic Foot Ulcers
Dr. Williams has observed that many diabetic patients don't seek specialized care until they've already developed serious complications. They manage their blood sugar, work with their primary care physicians or endocrinologist, and they may monitor their blood flow occasionally, and treat their pain with medications alone until their feet go numb, then hope for the best. By the time they develop chronic wounds or severe neuropathy symptoms, severe nerve damage has already occurred.
One major goal that has been overlooked for years, but has a significant amount of accumulating data from many medical centers in several countries, is the role of peripheral nerve decompression as an “icing on the cake” strategy to treat the compression of the swollen nerves caused by the diabetes itself in order to prevent the the downward spiral of loss of feeling, chronic pain, and loss of sympathetic signals to help regulate blood flow—all of which help prevent the formation of foot ulcers.
The research demonstrates that even patients with over 17-month-old ulcers can achieve remarkable healing through nerve decompression. However, Dr. Williams knows that patients who receive treatment earlier—before tissue damage occurs—have the potential for even better outcomes with far less risk of surgery and shorter recovery times.
Well-controlled diabetic patients often experience early signs of nerve compression that could be addressed surgically. These might include:
- Burning sensations in the feet. This fire-like pain often occurs when swollen nerves become compressed in tight spaces, creating abnormal electrical signals that your brain interprets as intense burning.
- Tingling or numbness. These "pins and needles" sensations develop when compressed nerves cannot properly transmit normal touch and pressure information from your feet to your brain.
- Loss of balance. When nerve compression reduces sensation in your feet, you lose the important feedback your brain needs to maintain steady balance and coordination while walking or standing.
- The early stages of foot drop. This weakness in lifting your foot occurs when the common peroneal nerve becomes compressed near your knee, making it difficult to clear your toes when walking and causing you to trip or drag your foot.
While these symptoms may seem manageable compared to open wounds, they represent opportunities for intervention that could prevent serious complications.
The study's patient selection criteria actually support this preventive approach. Participants needed good blood sugar control, adequate blood flow, and evidence of nerve compression through positive Tinel signs. These same characteristics exist in many diabetic patients who haven't yet developed ulcers but are experiencing nerve compression symptoms.
Early intervention offers several advantages over waiting for complications to develop. Nerves that haven't suffered prolonged compression retain better regenerative capacity. Blood vessels respond more readily to restored nervous system control. Nerves regenerate better when they are moderately compressed rather than after they have been strangulated for years and have damage. Furthermore, patients recover more quickly when they aren't dealing with infected wounds or extensive tissue damage.
Why Shifting From Treatment to Prevention Is the Smart Move
The traditional approach to diabetic foot care focuses on managing complications after they develop. Patients receive wound care, infection treatment, and sometimes amputation when problems become severe. This reactive approach, while necessary for advanced cases, misses opportunities for prevention.
Dr. Williams advocates for a more proactive approach based on the scientific evidence. Rather than waiting for ulcers to develop, well-controlled diabetic patients should be evaluated for nerve compressions that could be addressed surgically. This preventive strategy has the potential to eliminate many of the serious complications associated with diabetic neuropathy.
The research demonstrates that nerve decompression can restore the two key protective mechanisms needed to prevent diabetic foot complications: sensation and blood flow. When these functions are preserved or restored early in the disease process, patients maintain their ability to detect and respond to potential problems.
This preventive approach also offers economic advantages. The cost of early nerve decompression surgery is typically much less than the long-term costs associated with chronic wound care, multiple hospitalizations, and potential amputations. More importantly, however, patients avoid the pain, disability, and reduced quality of life that accompany advanced diabetic complications.
Don’t Wait to Take Action
If you have well-controlled diabetes (Hemoglobin A1c of less than 8.5) but experience nerve pain, tingling, burning, or numbness in your feet, this research provides compelling evidence for seeking specialized evaluation sooner rather than later. The study demonstrates that nerve decompression can achieve remarkable results even in patients with severe complications, suggesting it could be even more effective for those with earlier-stage problems.
Dr. Williams' expertise in peripheral nerve surgery, combined with his understanding of diabetic complications, allows him to identify patients who could benefit from early intervention. His comprehensive evaluation process determines whether nerve compression contributes to your symptoms and whether surgical treatment could prevent the development of serious complications.
The goal is not just to manage your current symptoms but to prevent the progression to ulcers, infections, and potential amputations that this research shows can be avoided. By addressing nerve compression before it leads to tissue damage, you have the opportunity to maintain healthy feet and an active lifestyle throughout your life with diabetes.