Surgical Decompression for Diabetic Sensorimotor Polyneuropathy
- David R. Cornblath, MD, FAAN1,
- Aaron Vinik, MD, PHD, FCP, MACP2,
- Eva Feldman, MD, PHD3,
- Roy Freeman, MD4 and
- Andrew J.M. Boulton, MD, FRCP56
- 1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 2Streltiz Diabetes Institute, Eastern Virginia Medical School, Norfolk, Virginia
- 3Department of Neurology, University of Michigan, Ann Arbor, Michigan
- 4Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- 5Department of Medicine, University of Manchester, Manchester, U.K.
- 6Department of Medicine, University of Miami, Miami, Florida
- Address correspondence and reprint requests to David R. Cornblath, MD, Meyer 6-181a, Johns Hopkins Hospital, Baltimore, MD 21287. E-mail: dcornbl{at}jhmi.edu
Diabetic neuropathy remains an unmet medical need. While scientific advances (1,2) have been made in understanding pathophysiology, the impact on the clinical care of patients has been minimal, aside from symptomatic treatments for the pain that may accompany diabetic sensorimotor polyneuropathy (DPN) (3). Improved glucose control is still the main recommendation for the prevention and treatment of DPN, based on studies conducted over 10 years ago. Recently, two evidence-based reviews (4,5) for the treatment of diabetic neuropathy have been published, which form the basis of the subsequent American Diabetes Association position statement (6) on the topic.
Into the apparent void of therapy for DPN, surgical decompression of multiple lower or upper limb nerves is being advocated as the treatment (7). The procedure is being utilized to treat symptomatic and generalized DPN. This approach is based on a series of hypotheses. First, the signs and symptoms of DPN are due to multiple nerve entrapments. In the lower limb, foot numbness is ascribed to “entrapment” of the peroneal nerve at both the fibular head and the anterior tarsal tunnel, the tibial nerve in the tarsal tunnel, and the sural nerve in the distal posterior calf. In …
