Diabetic peripheral neuropathy surgery

Surgical Treatment of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes. There are several theories as to why DPN occurs. One theory is that the increased level of sugar in the nerve creates an osmotic gradient, drawing water into the nerve. An osmotic gradient is a phenomenon that occurs as the result of a build up of solids adjacent to liquid. Over time, osmosis will try to evenly distribute the liquid. Osmosis causes the nerve to draw in water and causes the nerve to swell from the inside.

Internal swelling of the nerve places pressure on the nerve contributing to poor function of the nerve we call DPN. Mild to moderate cases result in loss of sensation and a tingle or painful buzzing sensation. The buzzing is so severe in some cases that it disrupts a person's sleep cycle keeping them awake all night and tired by day. Advanced cases of DPN result in motor loss of the hands, lower leg and foot.

There are three locations in the leg that are affected by swelling of the nerve that can result in DPN. These three sites include the common peroneal nerve at the lateral aspect of the knee, the deep peroneal nerve on the top of the foot and the posterior tibial nerve on the inside of the ankle.

Dr. Oster performs a surgical procedure for diabetic peripheral neuropathy called external neurolysis. External neurolysis is a release of the nerve from tissues that may bind the nerve and contribute to DPN. Candidates for this surgery are carefully chosen after a review of their general health and control of their diabetes. It's important that patients have their blood sugars well controlled before considering external neurolysis. Our office will perform a thorough history and physical exam before determining whether a patient is a candidate for external neurolysis.

External neurolysis is performed on an out-patient basis at a surgery center or hospital. The procedure takes less than an hour and is performed with the patient under a general anesthetic. Patients are able to walk on the foot the day of surgery. The surgical site must be kept dry for 14 days until the sutures are removed.

The following are images of external neurolysis procedures. The first row of images are external neurolysis of the posterior tibial nerve at the medial ankle. The second row are images of external neurolysis of the deep peroneal nerve of the top of the foot. And the third row show external neurolysis of the common peroneal nerve.

Posterior tibial nerve

Deep peroneal nerve

Common peroneal nerve