Comment on IWGDF ulcer prevention guidelines.

The IWGDF 2019 Updated Guidelines for prevention of foot ulcers in diabetes advise that nerve decompression surgery not be considered. This nerve decompression option has similar scientific supporting evidence to other surgeries which are recommended. The sanction ignores a large body of non-Level 1 evidence demonstrating various beneficial outcomes of ND including pain relief, DFU prevention, and protection from recurrence and amputation.

Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total.

Biologic Basis of Nerve Decompression Surgery for Focal Entrapments in Diabetic Peripheral Neuropathy.

The most recent (2011) National Diabetes Fact Sheet states the combined diagnosed and undiagnosed number of diabetes cases in the United States is approaching 25 million, and another 79 million are prediabetic. Of the diabetes patients, 60-70% suffer from mild to severe neuropathy. This combined loss of sensory and motor control in diabetic limbs is usually considered an irreversible, progressive process.

Nerve decompression after diabetic foot ulceration may protect against recurrence: a 3-year controlled, prospective analysis.

Background: Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade.

Methods: A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy, failed pharmacologic pain control, palpable pulses, and at least one positive Tinel's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain.

Reconsidering nerve decompression: an overlooked opportunity to limit diabetic foot ulcer recurrence and amputation.

Nerve decompression for relief of subjective diabetic sensorimotor polyneuropathy pain and numbness has been labeled of "unknown" benefit. Objective outcomes in treatment and prevention of diabetic foot complications are reviewed. There is growing evidence that plantar foot ulceration and recurrence in high-risk feet are minimized with this operation.

Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort.

Background: Use of nerve decompression in diabetic sensorimotor polyneuropathy is a controversial treatment characterized as being of unknown scientific effectiveness owing to lack of level I scientific studies.

Methods: Herein, long-term follow-up data have been assembled on 65 diabetic patients with 75 legs having previous neuropathic foot ulcer and subsequent operative decompression of the common peroneal and tibial nerve branches in the anatomical fibro-osseous tunnels.

Results: The cohort's previously reported low recurrence risk of less than 5% annually at a mean of 2.

Low recurrence rate of diabetic foot ulcer after nerve decompression.

Background: This study reevaluates the previously reported subjective benefits of surgical nerve decompression in diabetes with an easily observable, fully objective outcome measure to eliminate the placebo effect and observer bias.

Methods: A retrospective review was conducted of a series of 75 feet in 65 patients with diabetes and previous neuropathic ulcer who had surgical decompressions of the peroneal and posterior tibial nerve branches at anatomical fibro-osseous tunnels. After a minimum of 12 months of follow-up, the incidence of ipsilateral ulcer was assessed.

A review of therapeutic nerve decompression for neuropathy in Hansen's disease with research suggestions.

Nerve decompression surgery for leprosy neuritis has a long history and large literature. New understanding of the high frequency of spontaneous recovery from nerve function impairment requires re-evaluation of the value of decompression in acute nerve dysfunction with strong evidence-based protocols. Several reports and theoretical considerations suggest research avenues that might offer hope for prevention of long-term complications and relief of impairment and disabilities.

Early stage diabetic Charcot Foot syndrome may respond to nerve decompression.

Diabetic Charcot Foot syndrome has been postulated to require a triggering event to initiate its puzzling inflammatory process, characterized by bony resorption, pathologic fractures, soft tissue ligamentous failure, and destruction of foot architecture. Two cases are presented where multiple lower extremity nerve decompression was performed early in the Charcot process. Resolution of clinical signs and radiographic abnormalities rapidly followed.