Surgical Option Examined for Treating Diabetic Neuropathies

Plastic surgeons and specialists in diabetes, neurology, pain management, and rehabilitation are launching a study of peripheral nerve surgery to alleviate long-standing pain and numbness in patients with symptomatic diabetic neuropathy with chronic nerve compression (DNND).

Researchers at the University of Texas (UT) Southwestern Medical Center (Dallas, TX, USA) are hoping to show that by releasing pressure from specific nerves of the DNND patients, pain may be decreased and sensation improved. The study involves one year of close care and follow-up of 99 patients. As a part of the study, regular evaluations will be made by a foot care specialist, glucose management tips will be taught, and a specialized, non-invasive testing procedure will be conducted.

The risk of developing diabetic neuropathy increases the longer a person has diabetes, and it is estimated that up to 40% of diabetics have some form of neuropathy. About one-third of patients with diabetic neuropathy have overlying compression of certain nerves in the leg that may worsen the pain and cause loss of sensation at the bottom of the foot. Several studies have demonstrated that the nerves may increase in diameter in diabetic patients. For example, carpal tunnel syndrome, a medical term used to describe compression of the median nerve at the wrist, appears in approximately 2% percent of the general population, but in 15-30% of patients with diabetes. The treatment of choice in these patients, if conservative treatment has failed, is surgical nerve release.

In addition to pain, patients suffering from diabetic neuropathy have decreased sensation on the bottoms of their feet. Because they can injure their feet without noticing it, many develop ulcerations. Eventually, about one out of every six patients with ulcers will require an amputation, accounting for the nearly 100,000 amputations per year in the United States alone due to diabetes. Restoring protective sensation, so that diabetics will at least feel if they hit something with their foot, may decrease the amount of ulcers and eventual amputations in this high-risk population.

"Patients with neuropathy are often told that the problem is irreversible and that they cannot be helped,” said principal investigator Shai Rozen, M.D., an assistant professor of plastic surgery. "Diabetic neuropathy is a complex problem caused by multiple factors. We think pressure on nerves may be one component responsible for the symptoms in certain patients. This is very important to emphasize: Surgery may be helpful only in patients we suspect have pressure on their nerves in addition to their neuropathy and is not for all neuropathy patients.”


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University of Texas Southwestern Medical Center