Diabetic foot ulcers are common and estimated to affect 15% of all diabetic individuals during their lifetimes. The majority of foot ulcers are treated in outpatient settings where surveillance is limited. Hospital discharge data from select countries indicated that 6-20 % of all diabetic individuals hospitalized had a lower extremity ulcer condition.2•3 To illustrate trends in inpatient hospitalization, US National Hospital Discharge Survey Data (NHDS) data for seven foot ulcer related conditions from 1983 to 1990 will be used. These data revealed an overall increase of approximately 50% in the age standardized proportion of hospital discharges listing diabetes and lower extremity ulcers during this interval.2 The highest rates were observed in patients ages 45-64 years while the lowest rates documented were in patients ages 044 years. The age-standardized proportion of hospital discharges listing diabetes and lower extremity ulcers showed that diabetic foot ulcer rates were consistently

The epidemiology of diabetic foot problems

Background
Carpal tunnel syndrome is by far the most common peripheral nerve compression syndrome, affecting approximately one in every six adults to a greater or lesser extent. Splitting the flexor retinaculum to treat carpal tunnel syndrome is the second most common specialized surgical procedure in Germany. Cubital tunnel syndrome is rarer by a factor of 13, and the other compression syndromes are rarer still.

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Carpal and cubital tunnel and other, rarer nerve compression syndromes.

BACKGROUND The authors aimed to assess the effect of lower extremity nerve decompression surgery for painful diabetic polyneuropathy on pain and sensibility. METHODS The study was conducted as a single-center randomized controlled trial of one intervention with 1-year follow-up. Forty-two patients with painful diabetic neuropathy were included. After randomization, the lower extremity nerves were decompressed at four sites in one limb. The contralateral limb was used as control (within-patient comparison). All patients were assessed preoperatively and at 3, 6, and 12 months postoperatively. Primary outcome was the visual analogue scale score 12 months after surgery. Secondary outcomes were Semmes Weinstein monofilament testing and two-point discrimination outcomes at 3, 6, and 12 months. RESULTS Visual analogue scale scores improved significantly from a mean of 6.1 (95 percent CI, 5.5 to 6.7) preoperatively to 3.5 (95 percent CI, 2.5 to 4.4) at 12 months postoperatively (p<0.001). The score was also significantly lower compared with the control leg score of 5.3 (95 percent CI, 4.4 to 6.2; p<0.001) at 12 months. Overall, 73.7 percent of the patients improved their score on the visual analogue scale, of which 35.7 percent had a decrease of more than five points. CONCLUSION Surgical decompression of the nerves of the lower extremity can be added as a therapeutic option for patients with painful diabetic neuropathy who show signs of chronic nerve compression by means of a positive Tinel or other diagnostic criteria, when pain medication fails to reduce pain to an acceptable standard. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.

Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial.

Introduction
Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot.

There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity.

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Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

Objective
To investigate the effect of surgical decompression on painful diabetic peripheral neuropathy (DPN) patients and discuss the role which pain distribution and characterization play in the management of painful DPN as well as the underlying mechanism involved.

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Surgical decompression of painful diabetic peripheral neuropathy: the role of pain distribution

Objective. To evaluate the value of high-resolution ultrasonography and neural electrophysiology in early diagnosis, operative opportunity selection, and clinical effect assessment of DPN. Methods. Five hundred and sixty patients with diabetic peripheral neuropathy (DPN) were treated with DELLON surgical nerve decompression in our hospital in the past 5 years. Before and after 18 months surgery, the tests of the Toronto clinical scoring system, high-resolution ultrasonography, QST, and Nerve Conduction Velocity (NCV) were evaluated in all cases. The control group included 40 diabetic patients in the same age range but without DPN. Results. Ultrasonographic images revealed an apparently normal proximal common peroneal nerve, tibial nerve marked swelling, enlarged, and hypoechogeneity with loss fascicular pattern. The cross-sectional-area, anteroposterior and transverse diameter were measured preoperative and prooperative, and the differences had statistical significance（P < 0.01）. NCV-positive case...

Li Guowei

Papers

Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy.