Distinguishing Between Diabetic Peripheral Neuropathy and Nerve Compression: Understanding Two Common Causes of Nerve Pain in People With Diabetes

Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Provides Hope for People With Diabetic Nerve Pain

nerve decompression in people with diabetic neuropathy | Baltimore peripheral nerve surgeon Although it’s true that diabetic neuropathy can’t be cured, many people who have been told they’re suffering from diabetic neuropathy actually have nerve compressions that can be surgically addressed to reduce their pain and improve their overall quality of life. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has extensive experience helping diabetic patients with nerve compressions relieve their pain—and he may be able to do the same for you. 

About Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is the most common type of diabetic neuropathy. It affects the nerves that transmit information to and from the extremities, such as the arms, hands, legs, and feet. It's caused by damage to the small blood vessels that supply oxygen and nutrients to the nerves as a result of prolonged high blood sugar levels in individuals with diabetes.

Diabetic peripheral neuropathy often starts in the feet and legs and can gradually move to the hands and arms. In some cases, the symptoms might worsen at night, disrupting sleep. 

Diabetic peripheral neuropathy cannot be completely cured, but it can be treated. Treatment focuses on slowing the progression of the disease, reversing some of the changes to the nerves, preventing complications such as ulcers or infections that could lead to the need for amputation, and improving some of the severe pain problems that patients suffer from.

Understanding Nerve Compression in People With Diabetes

While there are many changes that occur from diabetes, the changes that a surgeon can help with are those that deal with the nerve compression disorders that diabetes contributes to.  Nerve compression, also known as nerve entrapment or a pinched nerve, occurs when a nerve is pressed or squeezed. Prolonged high blood sugar levels in diabetes can lead to inflammation and changes in the surrounding tissues, including the tunnels the nerves must travel through. When nerves can’t fit through tight tunnels, they become compressed and start to cause pain.

Nerve compression in people with diabetes can also be caused by:

  • Repetitive movements. Activities or occupations that involve repetitive movements can put pressure on nerves over time, leading to compression. For example, carpal tunnel syndrome can be caused by repetitive motions of the wrist, leading to compression of the median nerve.
  • Injuries or trauma. Accidents, injuries, or trauma to a specific area can cause swelling, inflammation, or direct pressure on nerves, resulting in compression.
  • Anatomical abnormalities. Some individuals might have anatomical variations that predispose them to nerve compression. For instance, a herniated disc in the spine can put pressure on spinal nerves. 

Multiple nerves can be compressed in patients with diabetes. For example, if both the top of your foot and the bottom of your foot are causing pain, you may have two different nerve compressions. 

Nerve compressions, even in patients with diabetes, can be surgically treated. Good results with improved pain levels, improved sensation, and improved balance are expected outcomes in the appropriate patient. 

Overlapping Symptoms Can Make It Hard to Obtain a Correct Diagnosis 

In people with diabetic peripheral neuropathy, nerve compression often goes undiagnosed because these two conditions can cause similar symptoms:

  • Pain (sharp, shooting, or burning)
  • Tingling or numbness
  • A “pins and needles” feeling
  • Weakness in the affected area
  • Feeling hypersensitive to normal stimuli, such as wearing tight pants or having bedsheets touch your feet at night
  • Muscle atrophy or loss of function 

When we evaluate patients in our office, one of the first things we look for is a positive Tinel sign. Sometimes called the Hoffman-Tinel sign, this is the “funny bone” feeling you get when you hit your elbow and it shoots into your little finger. You will get that same feeling on any nerve that is compressed or injured—and you can check for a positive Tinel sign at home if you wish to do so. 

If a positive Tinel sign is present in a patient with diabetes and nerve pain, there is an 85% chance they’re suffering from a nerve compression that can be surgically treated.  This even applies to patients who have been told for several years that they must simply live with pain from uncurable diabetic neuropathy. There are more than 15 years of scientific literature that back up the value of surgical nerve decompression as the standard of care for diabetic patients with pain from a compressed nerve. This has been shown in study after study from many different countries by many different authors.

Why Medication Isn’t the Answer

Typically, pain management teams treat nerve pain with medications, injections, or electrical stimulation. This may provide temporary relief, but it’s not a viable long-term solution because it does not address the underlying cause of your nerve pain. 

Imagine that your son or daughter is crying because they broke their arm, and you decide to stick a gag in their mouth. They’ll stop crying, but the gag isn’t doing anything to treat their broken arm. The only sensible solution is to take them to the emergency room to get a cast so their arm can heal properly. 

When a compressed nerve is causing pain, surgical nerve decompression is the only solution that will provide lasting pain relief.  

How a Peripheral Nerve Surgeon Can Help You Find Relief

Clinical studies have shown that surgical nerve decompression treats the underlying cause of your pain by relieving the excess pressure on the nerve. 

You might be a good candidate for nerve decompression surgery if you have:

  • Good blood sugar control with an A1C of less than 8.5 
  • A BMI (body mass index) under 50 
  • Good blood flow in the extremities, with a palpable pulse
  • No medical conditions that would affect your ability to tolerate surgical anesthesia

Although results vary depending on individual circumstances, our diabetic patients who have undergone nerve decompression typically report significant improvements in their symptoms and overall quality of life. For example:  

  • Getting back to an active lifestyle. After experiencing 24/7 pain and numbness in both feet from the knees to the top of the feet for 10 years and being told she was suffering from untreatable diabetic peripheral neuropathy, our patient was able to sleep pain-free and get back to leading an active lifestyle. 
  • Regaining sensation and function. After decompression of the proximal tibial nerve and common peroneal nerve, our patient had a ticklish foot and could once again move her toes. 
  • Relief from years of chronic pain. Our patient with a history of diabetic peripheral neuropathy and entrapment of the tibial nerve at the tarsal tunnel as well as the proximal tibial nerve in the calf saw substantial improvements in the numbness, tingling, buzzing, pain, and function of his toes several weeks after surgery. He had diabetes for three years and numbness and pain for approximately 10 years before visiting Dr. Williams. 

To learn more about the results Dr. Williams has been able to achieve with his patients, refer to the testimonials section of our website.