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Diabetic Neuropathy

There may be some optimism for patients with diabetes who suffer from peripheral neuropathy. By having yearly measurements made of the sensibility in your hands and feet, the earliest stages of neuropathy can be identified and appropriate changes in your diabetes management can be made. In certain cases, it may be found that areas are present in both your arms and legs that cause compression of your nerves. These sites of pressure on the nerves can be treated with surgery to restore sensation to your hands and feet.



Why would nerves in the diabetic be compressed?

Nerves begin in the spinal cord and extend into the fingers and toes.  Along this path there are anatomic areas of narrowing.  These exist in everyone, and many are already known to you, such as your “funny bone” at the elbow and the carpal tunnel at the wrist. In the leg, there are similar tight places at the outside of your knee and the inside of your ankle, called the tarsal tunnel.  Although some people may have been born with structures that would make the tunnels more narrow and the nerves more likely to become pinched, like a smaller wrist or extra muscles that go through one of these tunnels, the diabetic has two unique reasons to make nerves susceptible to compression. Firstly, diabetics may develop swollen nerves due to the high blood sugars. Secondly, these swollen nerves travel through tight tunnels that are stiffening over time, also due to the high blood sugars. The combination of these effects can create severe compression points on specific peripheral nerves.



What are the symptoms of nerve compression?

You will feel buzzing, tingling or numbness in the areas that are supplied by that nerve. In the foot, the problem similar to carpal tunnel syndrome is called tarsal tunnel syndrome.  It involves compression of the posterior tibial nerve in the bony tunnel on the inside of the ankle.   This nerve supplies the entire bottom of the foot, including the heel.  Compression of the posterior tibial nerve can result in numbness or tingling of the heel, the arch, the ball of the foot, and the bottom and tips of the toes.  The loss of sensation in the feet can cause a loss of balance, a feeling of unsteadiness, and cause you to fall. 



What type of surgery can be done?

The surgery to decompress the nerve does not change the basic, underlying metabolic (diabetic) neuropathy that made the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression, restoration of blood flow to the nerve will stop the numbness and tingling, and permit strength to recover.  When the decompression is done later in the course of nerve compression, and nerve fibers have begun to die, decompression of the nerve will permit the diabetic nerve to regenerate.

There may be some optimism for patients with diabetes who suffer from peripheral neuropathy. By having yearly measurements made of the sensibility in your hands and feet, the earliest stages of neuropathy can be identified and appropriate changes in your diabetes management can be made. In certain cases, it may be found that areas are present in both your arms and legs that cause compression of your nerves. These sites of pressure on the nerves can be treated with surgery to restore sensation to your hands and feet.