More than half of those with diabetes eventually lose nerve function in their feet, resulting in pain, tingling, numbness and even amputation because of infections. But a surgery similar to that used for carpal tunnel syndrome offers hope, if the condition is caught and dealt with before nerves die completely.
Pioneer Valley Hospital will open a center that focuses on diabetic neuropathy April 1. Last week, the hospital teamed up with Western Neuropathy Inc. to bring the man who devised the treatment to Utah to train local physicians.
Dr. A. Lee Dellon, professor of plastic surgery and neurosurgery at Johns Hopkins University School of Medicine, first became interested in the subject more than 20 years ago, when he saw that patients who had both diabetes and carpal tunnel syndrome benefited from enlarging the tunnel so that swollen nerves aren't pinched and rubbed. Could it work for feet as well? he wondered.
Most opinion at the time said no. Neuropathy was considered a progressive, irreversible complication of diabetes. Still, Dellon identified nerves in the feet and legs that ran through narrow channels that could pinch and injure them. In 1992 he used animals to prove that nerve decompression could alter the course of diabetic neuropathy.
Progress is slow. There are now 20 million diabetics in American and half of them develop neuropathy. As it worsens, they can develop infections and ulceration serious, even deadly complications of the disease loss of sensation, loss of balance. They may suffer falls and broken bones. Most of the time, said Dellon, treatment consists of being sure that blood sugar is under the best control you can achieve, then treating pain with medications. Diabetics with peripheral neuropathy are taught foot-care strategies. And that's "about all modern medicine has had to offer."
That's changing, though. Nerve damage occurs in part because sugar in the blood is converted to sorbitol, which craves and attracts water, pulling it into nerves and making them plump up, a big problem as they pass through tight channels. Left unchecked, the nerves die. After surgery to cut through ligaments to create a larger channel for the nerves at the ankle and feet, Dellon said his own patients with neuropathy had 90 percent of their pain relieved and 80 percent of their sensory loss reversed. Not one of his patients has lost a leg or foot or had an ulceration since the surgery, he said.
It doesn't work if nerves are dead. But if there are no indications of nerve death, a patient is not a candidate at this time. Candidates must be somewhere in between. If "thumping over a nerve" makes it tingle, 80 percent recover function with the surgery. In those without that response, it drops to 1 in 3. Besides that, "we can restore strength and balance to the muscles of the foot if treatment occurs before muscle wasting occurs."
Determining who's a candidate involves use of a "Pressure-Specified Sensory Device," a painless test that measures nerve degeneration and function in the hands and feet, without needles or shocks. Then in an outpatient operation under general anesthesia, the nerve channels can be opened up. Many patients feel relief within hours. Even with severe nerve damage, pain relief may be possible, though "the normal sensibility never returns," said Dellon, who also is professor of plastic surgery at the University of Maryland and professor of plastic and neurosurgery at the University of Arizona. He has trained 172 surgeons in 41 states and six countries in the past three years. Six doctors on the Wasatch Front are now trained, along with three others in the St. George area. To find one, click on the map at www.dellonipns.com.
A prospective surgical patient must be healthy enough to withstand general anesthesia, weigh less than 300 pounds and not have edema in the ankles, which blocks healing. It's also important to have good blood flow to the foot which lets out diabetics who have vessels clogged by heart disease. Dellon said that 80 percent of amputations, contrary to what one might think, result from neuropathy and not from other circulation problems.One of those most interested in the process is Jeffrey Hansen, president of HealthUtah, who said his insurance company will begin paying for the evaluation test for those it insures. One in seven healthcare dollars are spent on diabetes, he said. "Early diagnosis and treatment (of neuropathy) would save millions and improve quality of life."
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