Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy

Zhang, Wenchuan; Zhong, Wenxiang; Ye, Min; Shi, Jun; Li, Guowei; Ma, Qing-Bo

doi:10.3109/02688697.2013.798854

Cited by 34 publications

(35 citation statements)

References 16 publications

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“…Immediate pain relief in the recovery suite, bilateral pain improvement after unilateral surgery, and 80–92% of patients reporting relief were too astounding to believe, and no hypothesis for such an unexpected finding was proferred [17,21–25]. Not dispositive.…”

Section: The Skeptics Casementioning

confidence: 99%

“…Gondring et al [34] showed SWM monofilament evaluation of plantar sensation improved with tarsal tunnel ND, as did Mazilu et al [35]. Zhang et al [25] found post-op recovery of two-point sensibility to nearly normal levels. The level 1 EBM randomized control trial of Macare van Maurik et al [19] found lasting pain relief in operated limbs at 1 year, in comparison to the contralateral control limbs, which interestingly also improved and is pertinent to Cornblath et al’s [11] point 6.…”

Section: Subjective Outcomesmentioning

confidence: 99%

“…The Zhang et al [25] prospective study reports recovery of hallux pulp 2 point sensation from > 9 mm to near normal levels at mean 6.7 mm, in 560 advanced DSPN and DFU cases. Liao et al [33] confirmed this for both hallux and digiti minimi with a controlled, prospective study.…”

Section: Subjective Outcomesmentioning

confidence: 99%

“…A number of reports document such enlargement is present in DSPN, as measured by ultrasonography [25,38,41–44] and MRI [45]. …”

Section: Objective Outcomesmentioning

confidence: 99%

“…Zhang et al [25], Zhong et al [38], Liao et al [33], and Macare van Maurik et al [42] all report reduced size of nerve after ND. The latter series found the non-operated contralateral control leg nerve was also smaller, to a similar degree.…”

Section: Objective Outcomesmentioning

confidence: 99%

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Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

Nickerson¹

2017

Diabetic Foot & Ankle

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External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance.Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports’ potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqued in view of recent studies using objective, measured outcome protocols which nullify such potential confounders. Pain relief is now confirmed with Level 1 studies, and Level 2 prospective information suggests protection from initial diabetic foot ulceration and most neuropathic ulcer recurrences. In view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy, this secondary compression thesis and operative treatment methodology may deserve reassessment.

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Section: The Skeptics Casementioning

confidence: 99%

Section: Subjective Outcomesmentioning

confidence: 99%

Section: Subjective Outcomesmentioning

confidence: 99%

“…A number of reports document such enlargement is present in DSPN, as measured by ultrasonography [25,38,41–44] and MRI [45]. …”

Section: Objective Outcomesmentioning

confidence: 99%

Section: Objective Outcomesmentioning

confidence: 99%

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Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

Nickerson¹

2017

Diabetic Foot & Ankle

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Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Iborra¹,

Villanueva‐Martínez²,

Barrett³

et al. 2018

J of Ultrasound Medicine

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Objectives The purpose of the study was to determine whether ultrasound (US)‐guided surgery is a viable type of surgery for performing an effective release/decompression of the constricting structures that are responsible for focal nerve compression in tarsal tunnel syndrome. Methods Ultrasound guidance was used on cadaveric specimens to delineate the anatomic course of the nerves and vessels in the medial ankle that comprise the structures involved in tarsal tunnel syndrome. Ultrasound guidance was used on cadaveric specimens and assisted in delineating a safe surgical zone to adequately and effectively release these constrictive structures of the proximal and distal tarsal tunnels. The US‐guided tarsal tunnel release/decompression was performed through 2 small 1‐ to 2‐mm portals. After US‐guided release, anatomic dissection was used to check the efficacy (release of the flexor retinaculum and deep abductor hallucis muscle) and safety (absence of neurovascular or tendon injury) of the procedure. Results In 12 fresh cadaveric specimens, US‐guided release of the tibial nerve (proximal tarsal tunnel) and its branches (distal tarsal tunnel) at the medial ankle was effective in all 12 specimens (100% release rate), without any signs of compromise or injury into the neurovascular structures. Conclusions Ultrasound‐guided tarsal tunnel release is a feasible surgical procedure that can be safe and effective with the proper training, although further investigation is warranted. This type of surgery may promote faster recovery with less postoperative morbidity, including pain, but this will be the subject of a further investigation.

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Prophylactic Surgical Procedures in Plastic Surgery

Dilek

Aydın

2021

Prophylactic Surgery

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Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy

Cited by 34 publications

References 16 publications

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

Ultrasound‐Guided Release of the Tibial Nerve and Its Distal Branches: A Cadaveric Study

Prophylactic Surgical Procedures in Plastic Surgery

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