New Foot Surgery Eases Nerve Pressure and Prevents 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.

From the 2005 Annual Scientific Conference of the American College of Foot and Ankle Surgeons

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FACT:
Vitamin E Linked to Increased Risk of Heart Failure: The risk of heart failure was higher in the vitamin E group than in the placebo group (14.7 percent versus 12.6 percent), as was the risk of hospitalization for heart failure (5.8 percent versus 4.2 percent). The results of a seven-year study examining the potential benefit of vitamin E in preventing cancer and cardiovascular events in older patients with vascular disease or diabetes not only showed no benefit from taking the supplement, it showed an increased risk of heart failure, according to a report in the Journal of the American Medical Association, March 16, 2005.