Diabetic Neuropathy Treatment:

 

The Diabetic Neuropathy Nerve Decompression (DNND) treatment may help:

  • Burning or stabbing pain in your heel, arch, toes, or legs
  • Numbness and/or tingling sensations
  • Cold feet
  • Cramping and/or curling of your toes
  • Balance problems

 

The good news is that there are more than a dozen of published studies in several medical / surgical journals that show opitmism for patients with neuropathy.  Specifically, diabetic and idiopathic neuropathy patients have been shown to improve sensation and reduce pain. 

Dr. Rockmore has been performing the DNND treatment since 2006.  The most recent study is the first randomized controlled double blinded study.  This level 1 evidence based study shows that DNND in patients with DPN unequivocally reduces bilateral pain with statistical signficance at one year and 4 years, with greater reduction in pain in the decompressed limb at 4 years.  The results of this 4 year study were presented at the American Diabetes Associations's 77th Scientific Sessions 2017.   

To find out if this treatment is right for you, schedule a consultation with Dr. Rockmore in Hamilton or Summit.  Remember to bring the results of any testing that was done.  Or, simply call us to talk with Dr. Rockmore about your case.

 

The ultimate goal of the treatment is:

 

        1.  Reduced pain and reduced need for pain medicatiom

        2.  Improved sensation

        3.  Reduced incidence for ulcer and infection and amputation:

        

TESTIMONIALS from OUR patients with Diabetic Neuropathy:

"I was in a lot of pain before.... my toes were also numb...I didn't realize when I wore sandals that I was injuring my foot.  My foot feels great now and I would do it again if needed"

R.L. 

Trenton

 

"...my foot had numbness and my toes tingled.  Now my foot feels excellent - no problems.  I would highly recommend Dr.  Rockmore, and I do to all my friends."

T. Hartnett

Burlington

 

"...it would wake me from a sound sleep and I would walk the numbness off from anywhere, 1 hour to 3 hours in the early morning.  After surgery I got the feeling back in my toes and foot."

P. Alexander

Mercerville 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

How Does the Surgical Treatment Work? ............

1.  Neuropathy can lead to swollen and thickened nerves.  This is seen in the diabetic and other types of neuropathy.

2.  If a nerve is swollen near a bone or joint where it passes through a tunnel, it will now become squeezed and compressed because the tunnel does not enlarge with the nerve and the nerve is now too big for the space it is in, worsening the pre-existing nerve damage; causing increased pain and sensory loss.

3.  A one and a half hour procedure can open the tunnels and remove the pressure on the nerve, allowing it to recover from the insult of the compression; improving sensation and reducing pain and numbness.

4.  Patients are encouraged to walk immediately after surgery.

 

Triple 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.

When the nerves that have been "asleep" awaken, you may temporarily experience hot or cold or shooting pain in your toes. This is a good indication of recovery, but there still may be some discomfort to the patient. There is medication available that can help with this discomfort.

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. 
 

Surgical Treatment of Peripheral Neuropathy: Outcomes from 100 Consecutive Decompressions

Juan M. V. Valdivia, MD *, A. Lee Dellon, MD , Martin E. Weinand, MD * and Christopher T. Maloney, Jr., MD
* Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson.
Departments of Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD; Divisions of Plastic Surgery and Neurosurgery, Department of Surgery, and Department of Anatomy, University of Arizona, Tucson.
Divisions of Plastic Surgery and Neurosurgery, Department of Surgery, and Department of Anatomy, University of Arizona, Tucson; Dellon Institute for Plastic Surgery and Peripheral Nerve Surgery, Tucson, AZ.
Corresponding author: Christopher T. Maloney, Jr., MD, Dellon Institute for Plastic Surgery and Peripheral Nerve Surgery, 3170 Swan Rd, Tucson, AZ 85712.

Abstract

Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (J Am Podiatr Med Assoc 95(5): 451-454, 2005)

 

Using Diagnostic Ultrasound and Neurosensory Testing to Select Candidates for Nerve Decompression

Doohi Lee, MD * and Damien M. Dauphinée, DPM Texas Diagnostic Imaging PA, Plano, TX.
Foot and Ankle Associates of North Texas LLP, Lewisville, TX. Corresponding author: Damien M. Dauphinée, DPM, Foot and Ankle Associates of North Texas LLP, 500 N Valley Pkwy, Ste 100, Lewisville, TX 75067.

Abstract

It has been hypothesized that in individuals with diabetes mellitus the peripheral nerve is swollen owing to increased water content related to increased aldose reductase conversion of glucose to sorbitol. It has further been hypothesized that the tibial nerve in the tarsal tunnel is at risk for chronic nerve compression related to this swelling. We used diagnostic ultrasound to evaluate this hypothesis. Cross-sectional areas of the tibial nerve were measured in diabetic patients with neuropathy and compared with previously reported measurements in nondiabetic patients and diabetic patients without neuropathy. We used the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) to document the presence of neuropathy in 24 diabetic patients (48 limbs). Previous studies have found that the cross-sectional area of the tibial nerve in nondiabetic patients and in diabetic patients without neuropathy is not significantly different. We found that the mean cross-sectional area of the tibial nerve in diabetic patients with neuropathy is significantly greater than that in diabetic patients without neuropathy (24.0 versus 12.0 mm2). Our study highlights the value of newer ultrasound imaging techniques in identifying morphological change in the tibial nerve and confirms that the tibial nerve in the tarsal tunnel is swollen, consistent with chronic compression, in diabetic patients with neuropathy. (J Am Podiatr Med Assoc 95(5): 433-437, 2005)

 

Surgical Decompression in Lower-Extremity Diabetic Peripheral Neuropathy

Andrew J. Rader, DPM Patoka Valley Podiatry, PC, Jasper, IN; Center for Wound Healing, 1900 Medical Arts Dr, St Joseph's Hospital, Huntingburg, IN 47542.

Abstract

Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation.
(J Am Podiatr Med Assoc 95(5): 446-450, 2005)

 

Chemotherapy-Induced Neuropathy

The concept of nerve compression induced by separate pathology was extended to chemotherapy-induced neuropathy based upon a rat model of cisplatin neuropathy in 2001,30 and reported for the first time in patients with chemotherapy-induced neuropathy due to cisplatin and taxol in 2004.31 This first report contains just eight patients. They have had relief of pain and recovery of sensation from decompression of upper and lower extremity nerves. Chemotherapy regimens that contain vincristine, platin compounds, such as cisplatin or carboplatin, taxol, or thalidomide are known to cause a sensory neuropathy that is typically distal and symmetrical like diabetic neuropathy. This neuropathy is often painful. For cisplatin and taxol the mechanism that renders the peripheral nerve susceptible to compression is that binding of the chemotherapeutic agent to tubulin within the nerve's axoplasm, resulting in a decrease in the slow component of anterograde transport. The pain may be severe enough for the patient to stop chemotherapy, at which time nerve decompression would be appropriate. For other patients, the neuropathy symptoms, which for each drug are dose-related, may improve following cessation of chemotherapy. If the symptoms persist and are disabling, a positive Tinel sign identifies the location of the peripheral nerve compression site. Operative procedures in the lower extremity for chemotherapy-induced neuropathy are the same as those for diabetic neuropathy patients.

 

Chemotherapy-Induced Neuropathy: Treatment by Decompression of Peripheral Nerves

Dellon, A. Lee M.D.; Swier, Patrick M.D.; Maloney, Chris T. Jr. M.D.; Livengood, Melvin S. D.P.M., M.P.H.; Werter, Scott D.P.M.

Baltimore, Md.; Tucson, Ariz.; Greensboro, N.C.; and Myrtle Beach, S.C.

From the Divisions of Plastic Surgery and Neurosurgery, Johns Hopkins University; Department of Surgery, University of Arizona; Guilford Foot Center; and Coastal Podiatry.

Plastic surgeons encounter clinical problems related to cisplatin and tactual chemotherapy most often related to soft-tissue injury resulting from extravasation of the drug during intravenous infusion therapy. 1,2 Cisplatin 3-5 and paclitaxel, 6-8 however, each cause a painful chemotherapy-induced neuropathy resulting from their binding to tubulin in the axoplasm. This results in a decrease in the slow component of anterograde axoplasmic transport that makes the peripheral nerve susceptible to chronic nerve compression. In a study from 1984, postmortem histological examination demonstrated concentrations of cisplatin in the peripheral nerve at the same level as in the tumor, approximately 3 μg/g, whereas the cisplatin levels in the central nervous system were low, approximately 0.2 μg/g, because cisplatin does not cross through the blood-brain barrier. 3 A similar mechanism in diabetes results in a susceptibility to chronic nerve compression 9,10 that can be reversed by decompression of the peripheral nerve. 11 Clinical success with this approach has resulted in restoration of sensation and relief of pain in 80 percent of patients, including both upper and lower extremity nerve compression sites. 12-15 This subject has been reviewed recently. 16 Similar success in the basic science model of cisplatin neuropathy in the rat 17 provided a basis to apply this approach to patients with disabling symptoms of chemotherapy-induced neuropathy.

Plastic and Reconstructive Surgery: Volume 114(2) August 2004 pp 478-483