New Foot Surgery Method Eases Nerve Pressure From Diabetes; Helps Prevent Amputations

Main Category: Diabetes
Article Date: 13 Mar 2005 - 19:00 PDT


News from the 2005 Annual Scientific Conference of the American College of Foot and Ankle Surgeons -

Most diabetes patients know about the serious complications of their disease and the physical impairments that result. However, the nation's foot and ankle surgeons offered some encouraging news today about a new surgical technique to relieve nerve compression that may help new generations of diabetic patients avoid a serious outcome of the disease -- lower-leg amputations.

Diabetic foot care experts presenting at the American College of Foot and Ankle Surgeons Annual Scientific Conference said that in addition to diabetic foot reconstruction procedures to restore foot structure and function and plastic surgery to heal diabetic foot ulcers, foot and ankle surgeons are pioneering an approach to relieve pressure on nerves in diabetic feet that cause patients to lose feeling and develop serious foot ulcers.

Kent R. DiNucci, DPM, FACFAS, a Chicago-area foot and ankle surgeon presented data showing that a new surgical procedure allows nerves in diabetic feet to restore themselves, help patients regain sensation, and prevent troublesome foot ulcers from developing.

"It's a new way of looking at the old problem of diabetic neuropathy," said DiNucci. "Most nerve problems in the lower extremities are considered to be neuropathy in diabetic patients. Many, however, actually can be described as carpal tunnel syndrome of the feet because the nerves swell and are compressed by surrounding ligaments."

DiNucci explained that some nerves in the feet pass through "tunnels" formed by ligaments, which are called tarsal tunnels. In diabetes patients, nerves in the lower extremities enlarge from water build-up caused by elevated blood sugar levels. As the nerves enlarge, they get squeezed by the tarsal tunnels, which impede blood flow and eventually cause nerve deterioration.

"The new surgical approach is to release the tarsal tunnel to decompress the nerve and allow it to regain circulation and regenerate," said DiNucci. "For the best outcomes, diabetic patients should be evaluated as soon as they feel tingling or burning in their toes, well before extensive nerve damage occurs. This procedure isn't a cure for diabetic neuropathy, but it can delay eventual nerve degeneration."

He added that a study published late last year showed that 50 diabetic patients who underwent the nerve decompression surgery on one leg did not develop foot ulcers or required foot or lower-leg amputations. But the experience on the opposite leg was different, as 15 of them developed foot ulcers and three had amputations.

DiNucci noted that the procedure is the latest in the growing array of treatments foot and ankle surgeons offer to prevent diabetic patients from losing their feet.

"Today, we are treating a new generation of patients who are living long enough to develop advanced complications from diabetes and other chronic diseases," said Edwin Blitch, DPM, FACFAS, a foot and ankle surgeon practicing in Charleston, S.C. who was the moderator of the diabetic foot care session at the ACFAS meeting. "Looking ahead, as more Baby Boomers move into their sixties and seventies, they will want to remain as active as possible despite having diabetes, arthritis or cardiovascular disease. Therefore, in foot and ankle surgery, there will be an expanding focus on limb preservation," said Blitch.

He noted that advances in diabetic foot care have occurred in part by dispelling myths that existed about operating on diabetic patients. "Until recently, the consensus among physicians was that diabetic patients are poor candidates for surgery because they don't heal very well from surgical trauma," said Blitch. "However, we now know that many diabetic patients heal normally if they have good circulation, keep their blood sugar under control, and have good nutritional habits."

Due to physician reluctance to recommend surgery for diabetic patients, Blitch noted that previous generations were treated with conservative wound care methods; but in the last decade, new procedures used by foot and ankle surgeons are proving effective for healing diabetic foot ulcers and preventing their recurrence.

For further information about diabetic foot conditions and to locate a podiatric foot and ankle surgeon in your area, contact ACFAS at http://www.FootPhysicians.com.

The American College of Foot and Ankle Surgeons is the professional organization for foot and ankle surgeons, doctors of podiatric medicine (DPM) who are graduates of four-year podiatric medical colleges and have completed surgical residencies. The organization is dedicated to developing surgical standards for the care of the foot and ankle, sponsoring research, and providing continuing education for its members.

The American College of Foot and Ankle Surgeons
http://www.FootPhysicians.com

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