1 Foot 2 Foot

What is Neuropathy?

It is a general term that means nerve damage. The damage can be caused by many different things including diabetes, herniated or arthritic spines, drugs, high cholesterol and high triglycerides, injury, and compression (pinched nerves).

In this country, diabetes is the most common cause, but compression neuropathy is very common. In fact, it is estimated that 30% of people with diabetes have compression neuropathy. Carpal tunnel syndrome is the most common compression neuropathy. Tarsal tunnel syndrome in the foot, as well as numerous other nerve compressions, are commonly overlooked in the foot. Unfortunately, all too often neuropathy is assumed to diabetic neuropathy when in fact it is compression neuropathy of multiple nerves.

Dr. Dairman has advanced training in the diagnosis of peripheral nerve problems as well as the Dellon Procedure that has shown to:

• Reduce pain 90%
• Improve sensation 70%
• Reduce the ulceration rate and prevent foot infections and amputations

No matter what caused the neuropathy, the symptoms are the same. Neuropathy initially manifests itself as a tingling in the toes which gradually spreads up the feet or hands and worsens into a burning pain. The sensations, whether tingling or pain, can be either constant or periodic. A person with neuropathy can also experience muscle weakness or numbness. Weakness of the foot and leg muscles will eventually lead to hammertoes.

Diabetic Neuropathy is among the one of the most common complications of diabetes. Over time, diabetic neuropathy may occur in up to 50% of diabetics, despite controlling blood sugar. Once it occurs and without treatment, it almost always gets worse.

Diabetic neuropathy usually affects the feet first and then the hands. It starts with sensory changes such as numbness or tingling in the toes. At first these symptoms come and go, but then they become constant. Over a long period of time, the person may experience such a loss of sensation that he might not feel how tight his shoes are, know whether the bath water is hot or cold, or whether or not he has injured himself.

Changes in muscle strength also occur which leads to hammertoe deformities and possibly causing the diabetic to fall or the arches of his feet to collapse. Diabetic neuropathy is the leading cause of ulcerations and infections in the feet, and in advanced cases, amputation.

New testing and treatment has revolutionized care for diabetic neuropathy. The main methods of treatment, until now, have been rigorous control of blood sugar levels, meticulous care of the feet and the use of pain medication. The new testing procedures and specially developed treatment procedures can slow and even reverse the progress of this.

Testing Procedure: Quantitative Sensory Testing (QST)

It will tell the doctor the stage of a person's neuropathy so that appropriate treatment can be done. It also accurately diagnoses other conditions that have similar symptoms to neuropathy so the correct treatment can be performed. We are home to the Institute for Foot and Ankle Research and Technology and have access to this painless nerve testing equipment.

The American Diabetic Association recommends yearly testing for diabetics.

New Treatment for Neuropathy

Conservative methods of treatment, such as special shoe inserts, nerve blocks, nutritional and herbal medicines, or anodyne treatments (infrared light) can be used when neuropathy is in its early stages. If the neuropathy has progressed to the point where there is numbness and tingling throughout the day and weakness interferes with daily activities, then the person might be a candidate for Oral Medication like Lyrica or a surgical procedure like peripheral nerve decompression surgery. This is particularly suited to the treatment of tarsal tunnel (like carpal tunnel in the wrist but it is in the foot) neuropathy, with about an 80- 90% improvement rate. Ideally, surgery is done before there is no feeling left in the nerve and before the condition has worsened to the point of ulcerations.

Peripheral Nerve Decompression Surgery Diabetic & Non-Diabetic Neuropathy: The Theory

Dr. Dairman was trained by Dr. Lee Dellon, Professor of Neurosurgery and Plastic Surgery at John Hopkins University. Dr. Dellon made the discovery in 1988 that nerves were subject to compression and swelling in areas that were anatomically tight, such as the inside of the ankle thus causing symptoms of neuropathy.

With diabetics there are two reasons why a diabetic's nerves are subject to compression. The first reason is the propensity of a diabetic's nerves to swelling. Sugar from the blood enters into the nerve to give the nerve energy; this sugar, glucose, is converted into another sugar, called sorbitol. Sorbitol's chemical formula makes it attract water molecules and water is drawn into the nerve causing the nerves in a diabetic to be swollen. If a nerve swells in a place that is already tight, then the nerve becomes pinched, or compressed.

The second reason is related to the transport systems within the diabetic nerve. It is believed that proteins are transported to the nerve to keep it functioning normally. This mechanism does not work well in diabetics because of compression on the nerve in the nerve tunnels. The flow of proteins to repair the nerve is impeded. Opening the nerve tunnel allows the flow of proteins to resume.

In the case of non-diabetic neuropathy, the neuropathy may or may not be caused by swelling nerves, but is thought to be caused by tight nerve tunnels. Surgery may be effective in many cases where the neuropathy is unrelated to diabetes. Success rates in non-diabetic neuropathy are equal to those in diabetic neuropathy patients.

Peripheral Nerve Decompression Surgery: What to Expect

The surgery that is done for neuropathy is similar to the surgery commonly done for nerve compression in the wrist (carpal tunnel syndrome) and the ankle (tarsal tunnel syndrome). The surgery opens the tight area through which the affected nerve passes by, dividing a ligament that crosses the nerve. This opening gives the nerve more room, allows blood to flow better in the nerve and permits the nerve to glide with movements of nearby joints.

The surgery is performed in a hospital or a Surgery Center and takes about one to two hours, depending on the number of nerves that are affected. Most surgical patients have noted restoration of sensation and reduction of pain immediately after anesthesia wears off.

How does this type of surgery help diabetic neuropathy?

Most recent studies show that 80-90% of those diabetic patients who have had a nerve decompressed have had decreased pain and improved sensory and motor function with improved balance.

The surgery to decompress the nerve does not change the basic, underlying metabolic (diabetic) neuropathy that made the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression and nerve fibers have begun to die, decompression of the nerve will actually permit the diabetic nerve to regenerate or re-grow.

These patients with advanced neuropathy (ulcerations or lost toes) may recover less sensation because damage to the nerve has become irreversible. In this case, a consultation can determine how much help you can get from the surgery.