Diabetics and Peripheral Neuropathy
Peripheral neuropathy means malfunctioning of the nerves outside of the brain and spinal cord that serve to activate your muscles and provide sensibility to the feet and hands. The term includes an entrapment neuropathy such as carpal and cubital tunnel syndrome and tarsal tunnel syndrome. Peripheral neuropathy also includes generalized nerve decay process such as diabetic neuropathy, chemical neuropathy, alcoholic neuropathy, etc. The distinction is important because there is very little treatment available for non-entrapment neuropathy, while entrapment neuropathies if accurately diagnosed and treated before irreversible damage has occurred generally result in very good symptom relief. Non -surgical treatment is centered around hiding symptoms with medications that interrupt or reduce nerve activity or reduce the perception of nerve activity such as Lyrica (gabapentin), amitriptyline and its relatives, and Tramadol - a non-narcotic pain reliever. Only entrapment neuropathy generally has a good prognosis with predictable outcomes. Of a particular importance in this context is the misunderstanding with regard to diabetic peripheral neuropathy. A high percentage of diabetics develop a peripheral nerve disorder. This includes making the nerves more sensitive to external pressure; thus, it is very common for a diabetic to develop entrapment neuropathy. Many of the diabetic symptoms in the hands and feet are related to superimposed nerve entrapment and thus a treatable nerve entrapment such as carpal or cubital tunnel syndrome and tarsal tunnel syndrome needs to be excluded before condemning the diabetic person to a life of pain, numbness, and decreased ability to use the hand or walk from an untreatable nerve process. Decompressing diabetic peripheral nerves has been shown to have almost equal results to the nondiabetic if patients are carefully scrutinized. A side effect not anticipated with decompression of the tibial and peroneal nerves and their branches affecting the feet in diabetics is that of prevention of ulceration and healing of ulcers already present in selected patients with diabetes.
Dr. Ichtertz is also on the cutting edge of treating diabetic nerve entrapment to solve foot pain and prevent skin ulceration and ultimate leg amputation. To make this possible we have the first and only Pressure Specified Sensory Device in Nebraska.
|PSSD in use|
Dr. Ichtertz visited with A. Lee Dellon, M.D., Professor of Plastic Surgery and Neurosurgery at John Hopkins University Medical Center and author of over 350 scientific articles in 2003. The goal was to gain a full understanding of the technique and application of quantitative sensory examinations using the NMT Pressure-Specified Sensory Device (PSSD) which had been developed for the diagnosis and management of peripheral neuropathy - most specifically diabetic peripheral entrapment neuropathy. Dr. Ichtertz has added this to his clinical armamentarium and has utilized the technology to further enhance the diagnosis and improve the treatment of ulnar nerve entrapment, both nonoperative and operative.