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Dellon. Plast Aesthet Res 2022;9:45 Plastic and
DOI: 10.20517/2347-9264.2022.13
Aesthetic Research

Review Open Access

Nerve decompression in diabetics with chronic
nerve compression: update 2022

Arnold Lee Dellon

Department of Plastic Surgery and Neurosurgery, Johns Hopkins University, Baltimore, MD 89011, USA.
Correspondence to: Prof. Arnold Lee Dellon, Department of Plastic Surgery and Neurosurgery, Johns Hopkins University, 22 Via
Tiberius, Baltimore, MD 89011, USA. E-mail: aldellon@dellon.com

How to cite this article: Dellon AL. Nerve decompression in diabetics with chronic nerve compression: update 2022. Plast
Aesthet Res 2022;9:45. https://dx.doi.org/10.20517/2347-9264.2022.13

Received: 19 Feb 2022 First Decision: 19 Apr 2022 Revised: 18 May 2022 Accepted: 6 Jul 2022 Published: 19 Jul 2022

Academic Editors: Matthew Iorio, Joseph M. Rosen Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
The number of people with diabetes worldwide has reached epidemic proportions. Diabetics are well-known to
have chronic nerve compressions, and the prevalence of compressions exceeds 50% in those with neuropathy. The
loss of sensation in the feet of people with diabetic neuropathy is the primary cause of their ulceration and
amputation, as well as pain. The aim of this article is to update the reader on the current status of lower extremity
nerve decompression in patients with diabetic neuropathy. A review of the history and literature related to the
current approach to the patient with chronic nerve compression plus diabetic neuropathy was undertaken. The
current evidence is overwhelmingly clear, in diabetics with neuropathy and a positive Tinel sign over the tibial nerve
at the tarsal tunnel, that decompression, by neurolysis of lower extremity nerves, can relieve pain, restore
sensation, and prevent ulceration and amputation. Furthermore, economic cost-benefit analysis by the Markov
technique demonstrates that lower extremity nerve compression is not only cost-effective compared to standard
medical care, but also increases the quality of life and life expectancy. The remaining barriers to acceptance and
implementation of this proven surgical approach must lie in the education of physicians in training and re-
education of diabetes educators, primary care providers and endocrinologists.

Keywords: Diabetic neuropathy, neurolysis, decompression, Markov analysis, amputation

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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