I find it interesting that there’s really no one, single agreed upon theory to
explain the onset of diabetic peripheral neuropathy (DPN). One of the many theories describes intraneural edema, or swelling within the nerve. Swelling within the nerve is caused by a concentration of blood sugar in the nerve that creates an osmotic gradient, pulling fluid into the nerve. This condition is particularly problematic at sites where a nerve rounds an anatomical corner where it , may sustain physical irritation from movement of adjacent soft tissue and bone. Symptoms of intraneural edema include tingling and burning of the feet and legs. This condition is often called crush syndrome.
As a lower extremity surgeon, I’m often asked whether surgery is a method by which diabetic peripheral neuropathy can be treated. In all too many cases, the answer is no. But in some cases, if we think about the theory above, we actually can treat diabetic peripheral neuropathy with a surgical procedure. This surgery is called external neurolysis. External neurolysis is a technique whereby the surgeon releases the nerve from any entrapment. Carpal tunnel is a good example of external neurolysis. Although carpal tunnel isn’t traditionally performed to treat DPN, carpal tunnel surgery is the same technique where the outer (external) portion of the nerve is freed form any entrapment.
There are three location in the leg where entrapments of the nerves can commonly occur. Not all cases require that all three sites are treated. We refer to the number of affected sites by calling the condition, single crush syndrome (1 site), double crush syndrome (2 sites) or triple crush syndrome (3 sites).
Most importantly we have to ask: what is the success rate of external neurolysis for the treatment of diabetic peripheral neuropathy? I tell my patients to hope for 60% improvement. Is that too low? Maybe. But I want to build realistic expectations for these surgeries. But if I can help a patient to feel their feet again, I may indeed be helping to save their limb. When diabetic patients lose that ability to feel the floor, we call that ‘loss of protective sensation’ or LOPS. Feeling is key to avoiding infections and ulcerations of the feet. And restoring sensation can make a huge difference.
So is surgery indicated for the treatment of DPN? Maybe. You might want to sit and have a long talk with your doctor first to see if it may be indicated for you.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com




There’s a number of different ways that bone can be fixated when performing foot and ankle surgery. We use straight pins called K-wires, screws, plates, absorbable pins and a host of other devices. In the majority of cases, these pins are placed on a temporary basis to hold the bone stable so that it can heal. After healing is completed, the fixation device really has no additional benefit, and if possible, should be removed.


