The ultrasonographic evaluation of hemodynamic changes in patients with diabetic polyneuropathy after tarsal tunnel decompression

Teki̇n, Fati̇h; Ağladıoğlu, Kadir; Sürmeli, Mehmet; Ceran, Candemir; Bektaş, Hesna; Falcioğlu, Mehmet Çağatay; Yıldırım, İsmail Okan; Taner, Ömer Faruk

doi:10.1002/micr.22467

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…Tekin et al used US to evaluate the hemodynamic and morphological parameters in posterior tibial and dorsalis pedis arteries. 44 They studied 27 participants with DPN, pre-DNS and 3 months post-unilateral DNS. All measures showed statistically significant improvement post-DNS (described for the posterior tibial artery, as the dorsalis pedis results were comparable).…”

Section: Resultsmentioning

confidence: 99%

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Albers

Jacobson

2018

DMSO

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AimTo assess lower extremity decompression nerve surgery (DNS) to treat the consequences of diabetic distal symmetric peripheral neuropathy (DPN).Research design and methodsMEDLINE, PubMed, and related registries were searched through December 2017 to identify randomized, quasi-randomized or observational trials that evaluated the efficacy of lower extremity DNS on pain relief (primary outcome) or other secondary outcomes. Observational studies were included, given investigators’ reluctance to use sham surgery controls. Outcome effect size was estimated, and a weighted average was calculated.ResultsEight of 23 studies evaluated pain relief, including a double-blind randomized controlled trial (with a sham surgery leg), an unblinded trial with a nonsurgical control leg, and 6 observational studies. All reported substantial pain relief post-DNS with average effect sizes between two and five. Unexpectedly, the double-blind trial showed improvement in the sham leg comparable to the DNS leg and exceeding the improvement observed in the nonsurgical leg in the unblinded study. Sensory testing showed generally favorable results supporting DNS, and nerve conduction velocities increased post-DNS relative to deterioration in controls. Ultrasound revealed fusiform nerve swelling near compression sites. Morphological results of DNS were generally favorable but inconsistent, whereas hemodynamic measures showed a positive effect on arterial parameters, as did transcutaneous oximetry (improved microcirculation). The incidence of initial and recurrent neuropathic diabetic foot ulcers appeared reduced post-DNS relative to the contralateral foot (borderline significant).ConclusionThe data remain insufficient to recommend DNS for painful DPN, given conflicting and unexpectedly positive results involving sham surgery relative to unblinded controls. The generally supportive sensory and nerve conduction results are compromised by methodological issues, whereas more favorable results support DNS to prevent new or recurrent neuropathic foot ulcers. Future studies need to clarify subject selection vis-à-vis DPN vs superimposed compressed nerves, utilize appropriate validated instruments, and readdress use of sham surgical controls in light of recent results.

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Section: Resultsmentioning

confidence: 99%

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Albers

Jacobson

2018

DMSO

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“…Based on the results of Tekin et al concerning ultrasonographic evaluation of hemodynamic changes in patients with DSNP after tarsal tunnel decompression, it can be suggested that nerve release procedures have also a positive effect on the hemodynamic and morphological parameters of the arteries, as they pass through the anatomical tunnels nearby the nerves as well as positive effects on the neurological functions of the entrapped nerves [40].…”

Section: Discussionmentioning

confidence: 99%

“…Concerning applied surgical techniques, it has been seen that minimally invasive surgery for a tarsal tunnel release revealed the similar outcomes compared to open releases [28], at the same time minimizing soft tissue dissection, potential wound complications like infections and scar fibrotization with reducing time recovery and avoiding offloading [40].…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome—part III

Moroni

Gibello²,

Zwierzina

et al. 2019

Surg Radiol Anat

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BackgroundThe aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments.Methods and resultsThe study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet.ConclusionThe results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.

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“…Improvements were maintained or improved further from 3–18 months post-surgery in 36 of 40 limbs and decreased by 1 mm Hg in four. Tekin et al [55] report ND procedures have a positive effect on ultrasonic hemodynamic and morphological parameters (increased pulsatility and decreased resistance) of the dorsalis pedis and posterior tibial arteries.…”

Section: Objective Outcomesmentioning

confidence: 99%

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

Nickerson¹

2017

Diabetic Foot & Ankle

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External neurolysis of the nerve at fibro-osseous tunnels has been proprosed to treat or prevent signs, symptoms, and complications in the lower extremity of diabetes patients with sensorimotor polyneuropathy. Nerve decompression is justified in the presence of symptomatic compressed nerves in the several fibro-osseous tunnels of the extremities, which are known to be frequent in diabetes. Quite a body of literature has accumulated reporting results after such nerve decompression in the leg, describing pain relief and sensibility improvement, as well as balance recovery, diabetic foot ulcer prevention, curtailed ulcer recurrence risk, and amputation avoidance.Historical academic hesitance to endorse surgical treatments for pain and numbness in diabetes was based primarily on the early retrospective reports’ potential for bias and placebo effects, and that the hypothetical basis for surgery lies outside the traditional etiology paradigm of length-dependent axonopathy. This reticence is here critiqued in view of recent studies using objective, measured outcome protocols which nullify such potential confounders. Pain relief is now confirmed with Level 1 studies, and Level 2 prospective information suggests protection from initial diabetic foot ulceration and most neuropathic ulcer recurrences. In view of the potential for nerve decompression to be useful in addressing some of the more difficult, expensive, and life altering complications of diabetic neuropathy, this secondary compression thesis and operative treatment methodology may deserve reassessment.

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The ultrasonographic evaluation of hemodynamic changes in patients with diabetic polyneuropathy after tarsal tunnel decompression

Cited by 11 publications

References 26 publications

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome—part III

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

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The ultrasonographic evaluation of hemodynamic changes in patients with diabetic polyneuropathy after tarsal tunnel decompression

Cited by 11 publications

References 26 publications

Decompression nerve surgery for diabetic neuropathy:&nbsp;a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy:&nbsp;a structured review of published clinical trials

Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome—part III

Nerve decompression and neuropathy complications in diabetes: Are attitudes discordant with evidence?

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Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials

Decompression nerve surgery for diabetic neuropathy: a structured review of published clinical trials