Nerve Decompression Surgery for Patients with Type 2 Diabetes

This is a controversial topic, though I honestly don't believe it's that controversial. It's actually fairly straightforward from a surgeon's perspective. Took it to the lab, did research on rats, did research on humans, performed the procedures, documented the results, and then ultimately taught many, many physicians how to do this. More and more studies have been performed to the point where there's over 50 studies now through multiple different countries.

Diabetes As A Cause Of Nerve Pain

Because of diabetes and patients who have higher sugar levels, the sugar will travel into the nerve. It changes structure and then it cannot get out of the nerve, and therefore, it causes an osmotic gradient or it causes water to flow with the sugar. And when that happens, the nerve literally swells. And so when the nerve swells, the nerve takes up more room. And if you have a tunnel that's relatively tight and you have a nerve that gets bigger, it's just a matter of size. And on top of that, the diabetes and the extra sugar causes the tunnel itself to get firmer and harder. And the fascia, which is that fibrous tissue that creates the tunnel, gets stiffer and less resilient.

Tops their feet is the common peral nerve, which is pinched at the side of the knee at the fibular tunnel. And the sole of the foot is predominantly the tibial nerve, which is pinched either in the calf through an anatomic narrowing called the solal sling or the tarsel tunnel at the ankle, which then branches off into multiple branches of the medial plantar, lateral plantar, and calcal nerves. And that tibial nerve goes the entire sole of the foot. And so if you add a compression of the common peral nerve, which goes to the top of your foot, and you add a compression of the tibial nerve that goes to the bottom of your foot, now you have something that looks like a stocking or a sock where the patient will have burning, numbness, and tingling to both the top and the bottom of the foot.

Absolute most important standard for a surgeon is that the diabetes has to be under decent control. It has to be under good control. The patient also needs to be under reasonable weight, we generally draw the line around 300 lbs, which is pretty big. The patients also have to have normal, reasonable blood flow. If a leg or foot does not have normal blood flow, then the wound won't heal. And so the risks of surgery are too high for that situation. The patient could have a major wound breakdown and ultimately even end up losing their foot if they don't heal the wound. We typically draw a line around 85 years of age because in previous published literature by surgeons, the patients above 85 did not seem to get the relief that we were hoping for or the patient was hoping for. And we believe that's because the nerves have a much more difficult time regenerating as we get, as we age.

What we're looking for in patients who may be a candidate for a nerve decompression to improve pain, to improve sensation, to improve balance, to prevent, wounds in the future, is basically a live nerve that is still recoverable, that is has evidence of being pinched. And that comes from, we believe, the presence of a tenel sign. That is when we tap on the appropriate nerve in the right location, that patient should have an anatomically appropriate tingling into that distribution.

If no other medication or treatment available works, then surgical therapy is a very reasonable option because nothing else is a reasonable option. As a surgeon, our goal is to take the pressure off of a nerve that is pinched. And that's it. And it just happens to be that that actually makes a tremendous difference in many lives of patients who've been told for years that there is no treatment for their quote diabetic neuropathy.

Contact Dr. Williams To Learn More

If you or a family member are suffering from pain in the lower legs and feet related to diabetes, nerve decompression may be a solution to your pain. Contact Dr. Williams by filling out a form here or by calling 410-709-3868.