Tarsal tunnel release restores sensations in sole for diabetic sensorimotor polyneuropathy

Abstract

Background: Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy. Loss of sensations in sole leads to diabetic foot ulcers (DFU) and its complications. Surgical decompression has been used in the treatment of diabetic peripheral neuropathy, however; its effectiveness has been questioned. Purpose of this study was to evaluate the sensory recovery in sole after tarsal tunnel decompression (TTD) in patients having DSPN. Methods: Thirteen patients (Age28-70 years, average 35.57 years; 7 Males, 6 Females; 20 feet) with DSPN and positive Tinel's sign over the tarsal tunnel were included in the study. Pre and post-operative sensory tests performed on the sole included tests for touch, pain, temperature, pressure, vibration perception threshold (VPT) and two-point discrimination (2-PD). Results were classified as per British Medical Research Council (MRC) scoring system. Results: eSixteen feet were followed-up for 6 months. In all feet perception of touch, pain and pressure recovered. Temperature perception recovered in 75% feet. VPT came to normal range (16.81V) from 40.37 V and 2-PD came down to average of 6.0 mm from preoperative average of11.2 mm.MRC scale improved from S0 in 5 feet and S2 in 15 feet to S 3þ in all 16 feet.There were no ulcers or amputation in operated limbs during follow up period of 6 months. Conclusions: TTD improves plantar sensations in diabetic neuropathy and prevents ulcers and its related complications.

The sub-specialty of foot and ankle is evolving fast

“…To showcase the importance of foot and ankle disorders, we have included several high-quality reviews and original research articles, annotations, along with some very interesting case reports and technical tips. The variety of publications, in this special issue, range from fractures, 4,5 arthritis, 6 diabetic foot problems, 7,8 tendon transfer for the foot drop, 9 hallux valgus, club foot and Morton's neuroma. There are also articles on ultrasound-guided regional anaesthesia in foot and ankle surgery and on postoperative rehabilitation.…”

Lower Extremity Nerve Decompression for Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis

“…Aszmann et al 3 observed that peripheral nerve decompression in patients with diabetes improves sensibility and sensory impairment, and restores protective sensation. 38 Peripheral nerve decompression also enhances microcirculation in the feet, 39 improves the plantar sensations, and prevents ulcers and their associated complications. 40 Nerve decompression had a positive effect on the hemodynamic and morphological parameters of arteries as they pass through anatomical tunnels.…”

Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease

“…Sensory tests were performed on the sole in the territory of lateral plantar, medial plantar and calcaneal nerves. For the details of sensory tests readers can refer article by Agarwal et al 14 Sensory assessment was graded by British Medical Research Council (MRC) scoring system (range ¼ S0eS4). Patients required nerve transfer Nerve conduction velocity (NCV) of femoral nerve was done to confirm intact sensory supply of saphenous nerve.…”

“…Procedure for nerve decompression and nerve transfer was described elsewhere. (Figure-2, 3) For the details readers can refer article by Agarwal et al 14,15 .…”