Ulcers on the bottom of the foot are one of the most concerning complications of diabetes. Approximately 15% of all diabetics will develop an ulcer, and ulcers precede 84% of all diabetes-related lower-leg amputations. Of even more concern, the 5-year mortality rate following a lower-extremity amputation is almost 80%.
Once a person has had an ulcer, the risk of recurrence is very high. The incidence rate of recurrence is approximately 25-27% annually; over 60% will have a recurrence within 3 years (1).
Diabetic peripheral neuropathy is the leading risk factor for the development of diabetic ulcers. The damage to the nerves can lead to numbness, and, as blisters and sores appear on these numb areas, the injury goes unnoticed, eventually becoming an entry point for infection.
If numbness due to neuropathy is a primary concern in the development of a diabetic ulcer, it stands to reason that anything we can do to restore sensation would have a positive impact on lessening the risk of ulcer. In the past several years, studies have been conducted exploring the link between nerve decompressions in the lower leg and a lowered risk for ulcer development or recurrence.
At US Neuropathy Centers, our physicians have been extensively trained in diagnostic procedures to identify nerve compressions and surgical techniques to correct this problem. In many cases, immediate improvements are experienced.
Unrecognized nerve entrapment may frequently exist in patients with diabetic neuropathy. In an analysis of 15 scientific studies through 2006 (5), all of which included patients that underwent the Dellon triple nerve decompressions in the lower leg, it was found that these studies demonstrated relief of pain in 88% of patients and restoration of sensation in 79% of patients. One study showed that after 4.5 years, none of the 50 patients developed an ulcer in the operated leg, while 12 ulcers and 3 amputations occurred in the non-operated limb. That would seem to point to the effectiveness of nerve decompressions in lowering the risk for initial ulceration. A December 2013 prospective study of 516 patients with diabetic neuropathy further supports this possible conclusion; at 18 months following nerve decompressions, 0 patients had experienced an ulcer (4).
A recent retrospective review was conducted of a series of 75 feet in 65 patients with diabetes and a prior ulcer who had surgical decompressions of the peroneal and posterior tibial nerve branches at anatomical fibro-osseous tunnels. At a mean follow-up of 2 ½ years, the recurrence of ulcer in the decompressed limb was 4.28%, the lowest reported in the scientific literature (3).
If you are a diabetic who may be experiencing nerve symptoms in your feet and/or legs, it is important to be proactive. Contact one of our specialists at US Neuropathy Centers to schedule an appointment today! If neuropathy is present, there are many surgical and non-surgical options availability to start improving your quality of life.
The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
@US Neuropathy Centers, 2018
- Peters E, et al. Risk Factors for Recurrent Diabetic Foot Ulcers: Site Matters. Diabetes Care August 2007 vol. 30 no. 8; 2077-2079.
- Nickerson DS. Low recurrence rate of diabetic foot ulcer after nerve decompression. J Am Podiatr Med Assoc.2010 Mar-Apr;100(2):111-5
- Nickerson DS, Rader A.Nerve Decompression After Diabetic Foot Ulceration May Protect Against Recurrence. J Am Podiatr Med Assoc 104(1): 66-70, 2014).
- Zhang W, Li S, Zheng X. Evaluation of the clinical efficacy of multiple lower extremity nerve decompressions in diabetic peripheral neuropathy. J Neurol Surg A Cent Eur Neurosurg, 2012 Dec 18.
- Dellon AL. Neurosurgical preventation of ulceration and amputation by decompression of lower extremity peripheral nerves in diabetic neuropathy. Acta Neurochir Suppl 2007; 100: 149-151