[Surgical decompression of the lower leg in painful diabetic polyneuropathy].
OBJECTIVE
Surgical decompression of nerves of the lower leg should facilitate swelling-related pressure in diabetic polyneuropathic similar to carpal and cubital tunnel syndrome. Pain reduction, reduced need for pain medication, improved pedal sensitivity, improved balance and proprioception, and potential prevention of ulcerations and amputations are the objectives of the operation.


METHODS
Diabetic polyneuropathy with positive Hoffmann-Tinel sign over the tarsal tunnel and an ankle-brachial index >0.7.


METHODS
No Hoffmann-Tinel sign over the tarsal tunnel, no pain, no sensibility disorders, ankle-brachial index <0.7, body weight >140 kg. Relative contraindication: venous stasis and postthromobitic syndrome.


METHODS
Under general or spinal anesthesia, tourniquet, decompression of nerves of the lower leg in three locations: (1) common peroneal nerve at the fibula head with incision of the peroneus longus muscle, (2) tarsal tunnel with its four tunnels: (a) tibial nerve in the tarsal tunnel, (b) medial plantar nerve in the medial plantar tunnel, (c) lateral plantar nerve in the lateral plantar tunnel, (d) Rr. calcaneare in the calcaneal tunnel, (3) dorsum of the foot with decompression of the peroneus profundus nerve with excision of the extensor hallucis brevis muscle.


METHODS
No weight bearing for up to 3 weeks, suture removal after 3 weeks, water aerobics starting postoperative week 4.


RESULTS
A total of 12 patients (64±9 years) were operated and were followed up for 12±6 months. Procedure time was 83±27 min. Pain reduction on a visual analogue scale improved from 7.1±1.2 preoperatively to 3.3±2.4 postoperatively. Balance improved on a Likert scale (1=best, 6=worst) from 5±1 to 2±1, while sensory impairment improved from 5±2 to 3±1. There were no ulcerations or amputations. Two secondary wound healing problems at the ankle and one lower leg venous thrombosis 2 weeks following discharge were managed conservatively.
Plastische Hand- und Wiederherstellungschirurgie, Med. Hochschule Hannover. knobloch.karsten@mh-hannover.de
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Knobloch
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Gohritz
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Vogt
D000368:Aged; D055109:Ankle Brachial Index; D019299:Decompression, Surgical / Q000379:methods*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000294:innervation*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000601:surgery*; D010543:Peroneal Nerve / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D004856:Postural Balance / Q000502:physiology; D013641:Tarsal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D013979:Tibial Nerve / Q000601:surgery*