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Changing the Natural History of Diabetic Neuropathy: Incidence of Ulcer/Amputation in the Contralateral Limb of Patients With a Unilateral Nerve Decompression Procedure

Aszmann, Oscar MD*; Tassler, Patsy L. PhD; Dellon, A Lee MD

doi: 10.1097/01.sap.0000143605.60384.4e
Original Article
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The natural history of diabetes neuropathy is progressive and irreversible loss of sensibility in the feet, leading to ulceration and/or amputation in 15% of patients. The prevalence of neuropathy is more than 50% in those who have been diabetic for 20 years. Decompression of the tibial and peroneal nerves in those with diabetic neuropathy improves sensation in 70% of patients. The impact of this surgery on the development of ulcers and amputations in both the operated and the contralateral, nonoperated limb was evaluated in a retrospective analysis of 50 patients with diabetes a mean of 4.5 years (range, 2–7 years) from the date of surgery. No ulcers or amputations occurred in the index limb of these patients. In contrast, there were 12 ulcers and 3 amputations in 15 different patients in contralateral limbs. This difference was significant at P < 0.001. It is concluded that decompression of lower extremity nerves in diabetic neuropathy changes the natural history of this disease, representing a paradigm shift in health care costs.

A retrospective study was conducted on 50 patients with symptomatic diabetic neuropathy who underwent neurolysis of the peroneal nerve at the knee, deep peroneal nerve at the dorsal foot, and 4 medial ankle tunnels on 1 limb only. At mean 4.5 years, there were no ulcers or amputations on the operated limbs, whereas there were 12 ulcers and 3 amputations in 15 unoperated contralateral limbs.

From the *Department of Plastic Surgery, University of Vienna, Austria; the †Vermont Department of Health, Burlington, Vermont; and the ‡Division of Plastic Surgery and Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, and Division of Plastic Surgery and Division of Neurosurgery, Department of Anatomy, University of Arizona, Tucson, Arizona.

Received April 8, 2004 and accepted for publication, after revision, July 21, 2004.

Reprints: A. Lee Dellon, MD, Suite 370, 3333 N. Calvert Street, Baltimore, MD 21218. (Tel): 410-467-5400; (fax): 410-366-9825; E-mail: aldellon@erols.com.

© 2004 Lippincott Williams & Wilkins, Inc.