title: Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure.
abstract: 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.
authors.affiliation: Department of Plastic Surgery, University of Vienna, Austria.
authors.forename: Oscar
authors.initials: O
authors.lastname: Aszmann
authors.forename: Patsy L
authors.initials: PL
authors.lastname: Tassler
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D012677:Sensation; D013997:Time Factors; D016896:Treatment Outcome