Surgery for Diabetic Neuropathy

Diabetics are plagued with multiple complications secondary to uncontrolled, high levels of blood glucose. In my practice, I see diabetics who suffer from kidney disease, failing eye sight, and cardiovascular issues. The most noted complication is peripheral neuropathy. This is a progressive disease of the nerves in your feet and possibly the hands. Many treatments for neuropathy have been very unpromising, but new developments in surgical procedures may give patients hope.

It is believed that the some nerves in diabetic patients swell and increase in size secondary to increase water content. The nerves in your feet travel from your spinal cord all the way down to the feet. They curve around boney structures and dive through muscles and fat and run along course with arteries and veins. As the nerve enlarges it takes up more space and potentially gets compressed.

Much like carpel tunnel, a compressed nerve can cause numbness, burning, and pain. This pain is very similar to the pain experience by diabetics in peripheral neuropathy. A number of doctors have suggested that some diabetics have compressed nerves rather than permanently damaged nerves as previously perceived. Much of the research done on this concept is still very immature. Yet, many diabetics are undergoing surgery and experiencing a reduction in pain and an increase in sensation.

It is important to note that not all diabetics with peripheral neuropathy will have a successful procedure. It is very difficult to prove the pain or numbness is secondary to compressed nerves. Since it is a surgical procedure and there is always risk when undergoing anesthesia, not all diabetics will be recommended to undergo such surgical procedures.

There are also very few surgeons across the country you have been formally trained to perform nerve decompressive surgery for diabetic compressive neuropathy. The procedure has not been widely accepted at all institutions since the concept is so new. There has been a significant amount of research done on the surgical procedure, but the studies failed to established enough evidence to be widely accepted by the medical community.
F
or some patients, such surgical procedures may be acceptable and necessary to achieve relief. Unfortunately, these procedures are not indicated for all diabetics who suffer from peripheral neuropathy. It is important you understand the potential risks and benefits in considering such surgery. Not all patients find relief and some complication to surgery are increase of pain, decrease in sensations, infection and poor wound healing.

There has yet to be an accepted cure for diabetic neuropathy. The best treatment is to tightly control your diabetes and prevent the disease from progressing. Patients often find it necessary to be on one or several medication to help decrease the symptoms. Vitamin supplements and physical therapy modalities have also been suggested for treatment protocols.

Should I have Elective Surgery if I have Diabetes?

It is well known that diabetics are at risk for poor wound healing and infections. This leads many doctors and patients lean away from surgery. Some surgeries are necessary and can be debated, but other surgeries are elective and not life threatening. In Diabetics, there is a strong trend towards conservative care and surgery is nearly taken off the table for these patients. Can you have a safe surgery as a diabetic?

Diabetes is a disease that slowly affects the entire body. Diabetics have decreased blood flow, decreased sensation, and a compromised immune system. These problems do not happen overnight. but rather progress in relation to the blood glucose levels. The higher the blood sugars, the faster the disease progresses and the greater the damage it causes on the body.

Having surgery creates a wound and damages the surrounding tissues. During the recovery time, your body is trying to heal the damage the surgery has created including the wound in the skin. With decreased blood supply, a diabetic has a more difficult time heeling. Blood carries the necessary nutrients t and tools to promote wound healing.

It is very important for your body sense pain. After surgery, your body needs rest and time to recover. Nerves send important information from the surgical site to the brain to help guide the healing process. Diabetics suffer from neuropathy. The high blood sugar damages the nerves and alters a diabetic’s ability to sense pain.

There has been much research on the risks and benefits for diabetics to have elective surgery procedures. Research shows that the incidence of complication in elective foot and ankle surgery is less than 5%. In Diabetics the complication rate is about 13%. Further research has shown that uncomplicated diabetics, or those without neuropathy or peripheral vascular disease has an insignificant increase in risk.

If you are considering surgery and you are a diabetic, it is important to have a full work up. You should have a test done to check the blood flow in the legs. PVD, or peripheral vascular disease, is very common in the diabetic population and in the elderly. This can severely effect your ability to heel. Tests can also be done to determine your sensation lost. If you are area healthy diabetic with well controlled blood sugars with no other medical complication, surgery may still be an option for you.