What is neuropathy? Peripheral nerves create an intricate network that connects the brain and spinal cord to the muscles, skin and internal organs. Neuropathy is a disorder of the peripheral nerves that causes them to be damaged or diseased. The most common cause is diabetes . Other causes include chemotherapy, thyroid disorders, vitamin deficiency, a herniated disk in the spine, drug-induced, certain infections and alcoholism. When the cause is not known, it is called ‘idiopathic neuropathy.’
What is nerve compression? Nerve compression, or entrapment, refers to isolated peripheral nerve injuries that occur at specific locations where a nerve is constricted or compressed in a fibrous tunnel. The nerve can be damaged by either chronic compression or stretching forces, depending on the location. Nerves of people with diabetes are more prone to compression injuries. Common sites for compression injuries are in the carpal tunnel in the wrist and in the tarsal tunnel at the inside of the ankle which extends into the heel and arch of the foot. A common site of stretch injury is the outside of the leg just below the knee.
Symptoms of neuropathy are:
- Numbness, tingling, burning or stabbing pain in the feet.
- Open sores (ulcers) on the feet or legs.
- Pain in the feet and legs, especially at night.
- There may be cramping in the feet and/or curling of the toes.
- There may be weakness and loss of stability in the feet and legs.
Can nerve compression cause the same symptoms as neuropathy? YES! This is the basis for hope and optimism for people with neuropathy: The nerves in the feet and legs can be ‘decompressed’ with surgery.
How do I know if I have a neuropathy and a nerve compression? When pressure is applied to your nerves at known sites of compression and they are tender, then you have a nerve compression.
Risks associated with diabetic neuropathy:
Ulcers – One in six people with diabetes will develop an ulcer on their foot during their lifetime.
- Amputations – One in six people who develop an ulcer will require an amputation.
Currently in the U.S.A. there are over 90,000 amputations every year.
Published studies have shown that no person with neuropathy who has had nerve decompression surgery has developed a foot ulceration or has required an amputation.
Can neuropathy affect balance? Yes. As your nerves become further damaged, the muscles in your feet and legs weaken and you lose sensation in your feet. As a result, you can lose your balance. Without proper balance, you are at risk for falling, which may cause a broken bone, such as a wrist or a hip.
Is neurosensory testing necessary? Yes. Painless testing with the Pressure Specified Sensory Device™ (PSSD) documents the presence of neuropathy and determines the degree of nerve damage. This test result helps determine how quickly you will recover after surgery.
Medical treatment: If you have a form of neuropathy that can be treated medically, like diabetes, vitamin deficiency or low thyroid function, then you must see your medical doctor for the treatment of this specific disease. Often, by treating and controlling the underlying medical condition the symptoms of neuropathy can be relieved. When medical treatment does not help or when there is no known medical cause for your neuropathy, then prescription medications may be needed for the pain. You will need to see a pain management specialist for these drugs.
Nerve decompression surgery: There are three nerves in your feet and legs that give the “stocking distribution” to your symptoms. These nerves are decompressed by opening the fibrous canals through which they travel. Further information is available that gives specific details of the surgeries. The published outcomes of this decompression approach for the treatment of symptoms of neuropathy due to superimposed nerve compressions offer the best chance for relief of your symptoms.
Over 80% of people with neuropathy who are chosen for surgery get relief of pain and recovery of sensation. The nerve decompression surgery to restore sensation to your feet will also help to restore balance, therefore minimizing the risk of falling. Depending on the severity of nerve damage recovery may take up to one year.
What are the risks of surgery? Risks associated with the surgical procedure include the risk of anesthesia, bleeding and infection, and complications unique to decompression of nerves in the feet: the stitches at the ankle may break during walking, giving a prolonged time for wound healing. Depending on the severity of nerve damage, sensory recovery may take up to one year. In fact, there can be an initial worsening of pain as a nerve regenerates. This is a positive sign and occurs as small nerve sprouts send messages to the brain of hot and cold perceptions and buzzing. These sensations may continue for three to six months and will gradually subside; however, they may require short-term use of pain medication.
Who should do this surgery? Surgeons trained at the Dellon Institutes for Peripheral Nerve Surgery ® have the most advanced training and experience doing this type of nerve decompression surgery, which offers you the best chance for success. Dr. Talarico has completed extensive training at the Dellon Institutes ® and has been performing these procedures for over ten years. To schedule a complete evaluation call The Foot & Ankle Center, P.C. at (912) 330-8885.