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 tunnel syndrome (CTS), cubital tunnel syndrome (CTS), and tarsal tunnel syndrome (TTS). Peripheral neuropathy also includes generalized nerve decay such as diabetic neuropathy, chemical neuropathy, alcoholic neuropathy, etc. The distinction is important because there is very little treatment available for non-entrapment neuropathy, diabetic neuropathy, and alcoholic neuropathy, while entrapment neuropathies such as CTS and TTS 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 (pregabalin), amitriptyline and its relatives, and Tramadol. Only entrapment neuropathy generally has a good prognosis with predictable outcomes. Of particular importance in this context is the misunderstanding with regard to diabetic peripheral neuropathy. A high percentage of diabetics develop a nerve disorder. That makes the nerves more sensitive to external pressure. Therefore, it is very common for a diabetic to also 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, 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. An unexpected benefit of decompression of the tibial and fibular nerves affecting the feet in diabetics is that of prevention of ulceration and healing of ulcers already present in selected patients with diabetes.
To make this possible we have the first and only Pressure Specified Sensory Device in Nebraska invented by Dr. A Lee Dellon.
Dr. Ichtertz visited with Dr. Dellon, Professor of Plastic Surgery and Neurosurgery at John Hopkins University Medical Center and author of over 350 scientific articles. The goal was to gain a full understanding of the use of the Pressure-Specified Sensory Device (PSSD). Dr. Ichtertz has utilized this technology to further enhance the diagnosis and improve the treatment of ulnar nerve entrapment, both nonoperative and operative in diabetes and diabetics alike.
Many people diagnosed with “plantar fasciitis" actually have entrapment of a branch of the tibial nerve as it enters the heel hence the treatment of plantar facial release which actually decompresses the nerve branch. Usually, before offering surgical release for painful heel thought to be plantar fasciitis, stretching, shoot inserts to take direct pressure off of the heel and a cortisone injection are tried first.