Diabetic Neuropathy

Peripheral neuropathy is the term for damage to the nerves of the peripheral nervous system (any nerve outside of the brain and spinal cord). Neuropathy may be caused either by diseases of the nerve or from the side-effects of systemic illness. Systemic illnesses such as diabetes, even “pre-diabetes,” and thyroid disorders can lead to neuropathy symptoms. Other causes such as chemotherapy, arthritis, vitamin deficiencies, heavy metal toxicity, drug-induced, leprosy, and alcoholism can lead to neuropathy.

Common Neuropathy Symptoms

Typically the hands and/or feet are affected with symptoms of painful burning, tingling, numbness, cramping and/or weakness. Sometimes this distribution of symptoms is referred to as the “stocking & glove” pattern. At Florida Plastic Surgery Group, a common description from our patients with neuropathy is: “I awaken at night with a burning, cramping pain in my foot that I cannot shake or wring out.”

Can neuropathy be treated surgically?
If your neuropathy is classified as a “compressive neuropathy,” then you may be a candidate for surgical treatment. One of the main types of neuropathy, or “compressive neuropathy,” is due to focal pressure on a nerve. Nerves pass through fixed openings all over our body that allow for a certain space for the nerve to pass through. When a nerve is swollen – as occurs due to the metabolic effects of high blood sugar in diabetes, pre-diabetes, or thyroid disorders – it can become compressed at these fixed openings. A compressed nerve is not only tender at the site of compression but can lead to overall pain and numbness in the affected extremity. By surgically decompressing or relieving pressure on the intact nerve, pain may be decreased and sensation can return. In the legs, returning protective sensation is critical as it may prevent ulcer formation and ultimately prevent amputation. During peripheral nerve decompression surgery, the nerve is not cut. Common examples of this condition are carpal tunnel syndrome in the upper extremity or tarsal tunnel syndrome in the lower extremity.

What are non-surgical treatments for neuropathy?
If you suffer from neuropathy, you must see your primary care physician first to determine if the underlying medical condition can be treated to relieve your neuropathy symptoms. If medical management does not alleviate your neuropathy or you are not a surgical candidate, a pain management specialist may offer alternatives to help with your pain.

The Process

Am I candidate for neuropathy surgery?
The first step in our comprehensive treatment of peripheral neuropathy is to establish a diagnosis and work with your primary care physician, endocrinologist, neurologist to ensure that any underlying medical disease is adequately being treated. We will perform a comprehensive neurosensory examination of the affected limb to determine if you suffer from a “compressive neuropathy” that can be surgically treated.

I have a compression neuropathy, what is the next step?
Prior to the initial consultation:

• Complete our peripheral neuropathy questionnaire
• Obtain your records from prior treating physicians outlining previous treatment or diagnostic studies pertinent to your peripheral neuropathy

What happens during the initial consultation?
The initial consultation steps:

• One of our surgeons will review your history with you, perform a physical examination, and answer all your questions and concerns
• Our surgeon will identify if a focal compression site is present and surgically treatable to relieve your neuropathy symptoms

Surgery Expectations

Surgery is performed under general anesthesia under supervision of a board certified anesthesiologist.

For most patients, surgery is performed on an outpatient basis (you go home the same day). Depending on the number of focal compression sites treated, surgery takes 1-2 hours to perform. During peripheral nerve decompression surgery, the nerve is not cut.

What should I expect during my neuropathy surgery recovery?
Following surgery until the first visit (usually 7 days), we encourage patients to relax, elevate the operated limb, and not perform any strenuous activity. A compressive dressing is placed on the arm or leg until the follow up visit. If the leg was operated on, a walking boot is typically used to allow for limited walking, as elevation of the limb is imperative during the initial stages of the healing process. Activity is gradually increased and most patients are back to work and normal activity within 2-3 weeks. You are not able to drive or operate heavy machinery while taking any postoperative narcotic pain medication.

Some patients experience immediate pain relief, while for others it can take several months to a year for the results of the surgery to take effect. This variation depends on the amount of compression and the degree of nerve damage from the compression.

All sutures, except those used for the ankle, are typically dissolvable and do not require removal.

As peripheral nerve decompression relieves chronic pressure on the damaged nerves, some patients may experience shooting, stabbing, or electrical types of pain as their nerves are healing. These sensations are a sign that the nerve is regenerating and can usually be relieved with topical and/or oral medication until the sensations subside.

What is the success/risk of peripheral nerve decompression for neuropathy surgery?
Our goal is to reduce your pain and restore the sensation that helps with balance and protects you against ulcer development that would otherwise lead to amputation. Many patients are able to decrease or stop taking medications related to neuropathy pain after this procedure.

Other than the typical risks of general anesthesia & surgery, the main risk for this procedure is that you may still have areas of pain and/or numbness following your procedure.

If you would like to learn more about how our surgeons can help relieve your diabetic neuropathy pain, please contact a member of our staff at Florida Plastic Surgery Group today.