The patient is ideally allowed to walk the same day as the procedure, and the complication rate has been very small with the most common complication being a partial wound dehiscence easily managed by local wound care.¹⁹ It is imperative, however, that the vascular status of the patient is evaluated and determined to be adequate, usually with an ankle brachial index (ABI-the ratio of the blood pressure in the lower legs to the blood pressure in the arms)-of ≥0.7 (which is adequate perfusion to safely perform surgery, though normal ABI is 1.0 to 1.2) with palpable pulses and little trophic change to the skin.¹⁸ In fact, this surgery is now being implemented into limb salvage surgery regimens.¹⁹
![div 3 decompressor div 3 decompressor](https://golfbase.co.uk/media/catalog/product/cache/0/image/1200x1200/602f0fa2c1f0d1ba5e241f914e856ff9/4/0/400896_9nb_1.jpg)
This is simply not true, and in fact, more foot surgery is performed on patients with diabetes than without. First, in some provider groups there is a misperception that it is not safe to operate on a patient with diabetes. While it is not within the scope of this article to discuss the specifics of the surgical techniques, there are some points that the reader might find helpful. There has been extensive research into the effects of peripheral nerve decompression done for the treatment of DPN symptoms, and in particular tarsal tunnel decompression.¹⁴˒¹⁵ In more recent study, greater effects were seen when the common peroneal nerve was decompressed in addition to the tarsal tunnel.¹⁶ This not only means that symptomatic DPN can be effectively treated via surgical nerve decompression, but that surgical decompression can prevent the complications of DPN from developing.¹⁷ Preoperative Evaluation Immediate sensory improvement with improved motor function is often seen in the postoperative acute care unit after nerve decompression.
![div 3 decompressor div 3 decompressor](https://file.scirp.org/Html/6-6801170/7161b7b1-07e4-49b1-b0fa-0e54d05cd614.jpg)
Interestingly, when evaluating patients with diabetes after lower extremity peripheral nerve decompression, Maloney et al showed a predictive success rate of 88% for decompression of patients’ lower extremities.¹³What occurred was that the focal nerve entrapment was relieved (the true pain generator), and their pain disappeared or was greatly diminished.
![div 3 decompressor div 3 decompressor](https://www.meiersupply.com/ecomm_images/items/medium/laha032etac800_lg.png)
“What can you do for my feet?” Why would the same concept not apply to the lower extremities? Certainly nothing metabolic has been changed by surgery! The researchers then went on to discover that if the ulnar nerve, and subsequently the radial sensory nerves, were surgically decompressed, most of these patients would then regain sensation in the remainder of their previously “gloved” distribution of “polyneuropathy sensory deficit.” It is easy to visualize how this combination of peripheral nerve compressions can produce a “glove” effect.⁶ These pleasantly surprised and satisfied patients had another question for the surgeons. It is well documented that the pain and symptoms of carpal tunnel syndrome can be relieved by peripheral nerve decompression in the diabetic patient.⁶⁻¹² In the 1980s, MacKinnon and Dellon noted that most diabetic patients with carpal tunnel syndrome and symptoms of peripheral neuropathy-such as numbness and tingling in their hands-regained their sensation after carpal tunnel decompression surgery.⁶ The patients’ pain also improved, if it was not completely eliminated.