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Surgical Treatment of Peripheral Neuropathy

Outcomes from 100 Consecutive Decompressions

Juan M. V. Valdivia Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson.

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A. Lee Dellon Departments of Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD; Divisions of Plastic Surgery and Neurosurgery, Department of Surgery, and Department of Anatomy, University of Arizona, Tucson.

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Martin E. Weinand Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson.

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Christopher T. Maloney Jr. Divisions of Plastic Surgery and Neurosurgery, Department of Surgery, and Department of Anatomy, University of Arizona, Tucson; Dellon Institute for Plastic Surgery and Peripheral Nerve Surgery, Tucson, AZ.

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Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (J Am Podiatr Med Assoc 95(5): 451–454, 2005)

Corresponding author: Christopher T. Maloney, Jr., MD, Dellon Institute for Plastic Surgery and Peripheral Nerve Surgery, 3170 Swan Rd, Tucson, AZ 85712.