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Low Long-Term Risk of Foot Ulcer Recurrence After Nerve Decompression in a Diabetes Neuropathy Cohort

D. Scott Nickerson Northeast Wyoming Wound Clinic, Sheridan, WY.

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Andrew J. Rader Wound Care Center, Memorial Hospital and Health Care Center, Jasper, IN.

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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 2.49 years of follow-up has persisted for an additional 3 years, and cumulative risk is now 2.6% per patient-year. Nine of 75 operated legs (12%) have developed an ulcer in 4,218 months (351 patient-years) of follow-up. Of the 53 contralateral legs without decompression, 16 (30%) have ulcerated, of which three have undergone an amputation. Fifty-nine percent of patients are known to be alive with intact feet a mean of 60 months after decompression.

Conclusions:

The prospective, objective, statistically significant finding of a large, long-term diminution of diabetic foot ulcer recurrence risk after operative nerve decompression compares very favorably with the historical literature and the contralateral legs of this cohort, which had no decompression. This finding invites prospective randomized controlled studies for validation testing and reconsideration of the frequency and contribution of unrecognized nerve entrapments in diabetic sensorimotor polyneuropathy and diabetic foot complications. (J Am Podiatr Med Assoc 103(5): 380–386, 2013)

Corresponding author: D. Scott Nickerson, MD, Northeast Wyoming Wound Clinic, 1401 W 5th St, Sheridan, WY 82801. (E-mail: thenix@fiberpipe.net)