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Baltimore Peripheral Nerve Surgeon Eric H. Williams MD Explains How to Tell If Nerve Decompression Surgery May Be an Option for Treating Your Nerve Pain

Are you living with diabetic neuropathy? There may be hope you haven't considered. While it's true that diabetic neuropathy itself may be difficult or impossible to cure completely, many patients diagnosed with this condition may have TWO problems: diabetic neuropathy AND a nerve compression. It may be the compression problem that is causing most, if not all, of the symptoms that bring the patient to the doctor’s office. Treatable nerve compressions are frequently misdiagnosed or simply completely ignored. 

Almost all of the emphasis in today’s care environment is focused on the treatment of diabetes, and while this is completely appropriate to aggressively control one’s blood sugars, what happens if the pain, burning, numbness, and tingling do not go away with good sugar control?  Is a patient just supposed to give up?  Just live with the pain?  Live with severe numbness and loss of balance? 

If a nerve is compressed, whether the patient is diabetic or not, we can treat it in most patients by decompressing the nerve. If a nerve is pinched, it needs to be unpinched, or it will die. Nerve decompression procedures in the appropriate patient can reduce pain and improve quality of life. The challenging part is trying to determine who is the “appropriate patient.”  

Dr. Eric H. Williams, a renowned peripheral nerve surgeon in Baltimore, has helped many well-controlled diabetic patients find relief from pain caused by nerve compressions. Don't let a potentially treatable condition hold you back any longer. Let’s look at some factors that suggest you may be a good candidate for this life-changing surgery.

Positive Tinel Sign

Named after Jules Tinel, a French neurologist who first described it in 1915, the Tinel's sign is a simple yet powerful diagnostic tool for the peripheral nerve surgeon. You can check for positive Tinel sign from the comfort of your own home. Here’s a video tutorial:

 

When you tap along the path of a nerve, a tingling or "electrical" sensation in the nerve's distribution area indicates potential irritation, compression, or injury. (This is the same “funny bone” feeling you get when you hit your elbow and it shoots into your little finger.) 

A positive Tinel's sign suggests that the nerve at the tapped location is experiencing some form of disruption in its normal function. If a positive Tinel sign is present in a diabetic with nerve pain, there is roughly an 85% chance they’re suffering from a nerve compression that can be surgically treated, EVEN IF they have been diagnosed with “diabetic neuropathy”. 

However, you don’t necessarily need to worry if you’re not able to reproduce this at home. Sometimes it takes someone with more training than just a video at home to find it. The Tinel sign is just one piece of the diagnostic puzzle that Dr. Williams will consider to determine if you’re a good candidate for surgery. 

Good Blood Sugar Control 

If you're hoping to undergo nerve decompression surgery, Dr. Williams will want you to have good blood sugar control. This is typically indicated by an A1C of less than 8.5. If you are diabetic or live with someone who has diabetes, you probably know what this means.  

The A1C test measures your average blood sugar levels over the past 2-3 months, giving a broader picture of your glucose control than daily finger pricks. An A1C below 8.5% suggests that you've maintained relatively stable blood sugar levels over time.

You might wonder why your blood sugar levels are so crucial when you're dealing with nerve pain. High blood sugar can significantly slow down the wound-healing process. After surgery, you want your incisions to close quickly and properly to reduce the risk of complications.  Also, having good sugar control can actually improve the level of compression and reduce the pain and numbness in the hands or feet.  

If your A1C is currently above 8.5%, your health care team can work with you to improve your diabetes management before surgery. This might involve:

• Adjusting your medication regimen
• Fine-tuning your diet
• Incorporating more physical activity into your routine
• More frequent blood sugar monitoring

Weight Guidelines

BMI, or Body Mass Index, is a simple measure that uses your height and weight to work out if your weight is healthy. The formula divides your weight in kilograms (kg) by the square of your height in meters (m2). While it's not a perfect measure of body fat or overall health, it provides a quick and easy screening tool for weight categories. (The CDC has an easy-to-use BMI calculator if you’re not sure what your number is or don’t want to bother converting from the metric system.) 

Specifically, a BMI under 50 and a weight of under 350 pounds is necessary for nerve decompression surgery for diabetic neuropathy. To put this into perspective:

• A BMI of 18.5 to 24.9 is considered normal weight
• 25 to 29.9 is overweight
• 30 to 39.9 is obese
• 40 and above is severely obese

Severe obesity can complicate surgery and recovery. For example, administering and managing anesthesia can be more challenging in patients with very high BMIs. There's an increased risk of breathing problems, blood clots, wound healing problems, infections, and other complications during or after surgery.

If your BMI is over 50 or you weigh more than 350 pounds and you're hoping to undergo nerve decompression surgery, your health care team may recommend weight loss strategies to improve your surgical candidacy and overall health. For example, a medically supervised weight loss program can provide structured support, monitor blood sugar control, reduce pain, and enhance your overall quality of life.

Good Blood Flow in the Extremities

Your blood carries oxygen and nutrients that are necessary for tissue repair and fighting off potential infections. Good blood flow is also vital for the overall health of your nerves and surrounding tissues. This helps maintain nerve function and supports the regeneration process after nerve decompression surgery. 

Dr. Williams will check for a palpable (detectable) pulse in your extremities. This simple test can indicate whether you have sufficient blood flow to support healing after surgery.

If there are concerns about your blood flow, he may recommend further vascular assessment. This could include an ankle-brachial index (ABI), which compares blood pressure in your ankle to that in your arm. An ABI of .85 indicates that you may be a good candidate for nerve decompression surgery. 

If circulation issues are detected, your health care team may recommend treatments to improve blood flow before considering surgery. These could involve medications, lifestyle changes, or, in some cases, vascular procedures to increase blood flow to the leg.

Able to Tolerate Anesthesia 

Your anesthesiologist will review your medical history, current medications, and any previous experiences with anesthesia.

While generally safe, anesthesia does carry some risks. These risks can increase if you have certain medical conditions. These could include:

• Severe heart or lung disease
• Uncontrolled high blood pressure
• Certain neurological conditions
• Sleep apnea
• Obesity (which ties back to the BMI considerations we discussed earlier)

No Open Wounds

One often overlooked factor that can make you a promising candidate for peripheral nerve surgery is the absence of open wounds on your feet or legs. Open wounds, particularly in diabetic patients, can be a sign of advanced neuropathy and poor circulation, which may complicate surgical procedures and healing. 

A lack of open wounds indicates that you may be in an earlier stage of neuropathy, where nerve compression is more likely to be the primary issue rather than extensive nerve damage. If this is the case, addressing your nerve compressions before they lead to more severe complications often yields better outcomes. 

Desire to Stop Relying on Pain Medications

Medications can temporarily muffle the symptoms of nerve pain, but they do not address the underlying issue that is causing your symptoms. If you have a nerve that is stuck, trapped, or compressed, clinical studies have shown that surgical treatment can lead to improved pain levels, improved sensation, and improved balance. 

You can learn more about the results Dr. Williams has been able to achieve with his patients with compressed nerves in the setting of diabetic peripheral neuropathy—including how surgery reduced or eliminated the need for pain medication—by referring to the testimonials section of our website.

Age Considerations

While there's no strict cutoff for nerve decompression surgery for diabetic neuropathy, Dr. Williams typically prefers patients to be under 85 years old. 

As we age, our body's ability to heal and recover from surgery starts to decline. People under 85 generally have better tissue repair capabilities, which is crucial for successful post-operative recovery. The immune system also weakens with age, potentially increasing the risk of post-surgical infections. 

We know that the nerves of a 90-year-old do not heal as well as the nerves of a 20-year-old, so the results from decompression surgery may not justify the risks of surgery at this point. 

Of course, it’s important to note that being over 85 doesn't automatically disqualify you from surgery. The age of 85 is more of a guideline than a strict rule and Dr. Williams will consider your unique situation.  This includes factors such as:

• Your overall health 
• Your physical fitness and activity level
• Your social support and ability to follow post-operative care recommendations
• The benefits of surgery versus the potential risks

Some patients over 85 may be excellent candidates for surgery if they're in good overall health and have a strong support system. Conversely, some younger patients might not be suitable candidates due to other health issues. Dr. Williams will be able to provide additional guidance after reviewing your medical records. (Learn how to prepare for your first visit with Dr. Williams.). 

Diabetic peripheral neuropathy (DPN) is a type of nerve damage that affects the extremities in people with diabetes. It is caused by high blood sugar levels that damage the nerves over time. The condition can affect people in different ways but is often described as: 

• Tingling in the feet and hands
• Intense burning
• Severe pins and needles
• Feeling like your feet are covered in ants
• Feeling like you’re walking on barbed wire
• An overall feeling of numbness that makes it hard to keep your balance

Until recently, it was felt that DPN was an incurable disease that was irreversible and would progressively worsen over time. Treatments typically focus on managing symptoms and preventing further damage. This often includes diet, exercise, and medication. We agree with aggressive control of blood sugar levels as the mainstay of trying to slow or halt the progression of symptoms. We are also thankful that there are some medications that can improve painful symptoms of neuropathy symptoms, but treatment doesn’t need to stop here. 

Over the past 15 years, there has been a growing level of evidence from different physicians and countries that surgical decompression of the affected nerves can have a profound effect on the health of the nerves badly affected by changes associated with DPN. It has been shown that diabetes causes sugar to move into the nerves itself. This sugar then can not get out and it brings water with it. Imagine how your fingers swell after eating a bunch of salty food.  How hard is it to get a ring off the finger? Why is that? Well, the finger swells but the ring around it does not change size. This is exactly what happens when the nerve swells, but the tunnel that the nerve travels through does not get bigger. The blood supply to the nerve gets cut off.  

It is not rocket science to determine what can happen next. Less blood flow equals less function.   Nerves start dying. When nerves start dying, they start talking to you to let you know it—they burn, they tingle, they send shocks, they lose feeling, and the muscles stop working.  

There are entire textbooks on all the other changes that occur in a nerve due to diabetes. Surgeons are not able to help many changes that can occur, but the work done by Dr. Dellon and others in the past 15 years has reinforced the idea that many of the symptoms that well-controlled diabetic patients complain about can improve by taking pressure off the nerves as they travel through tight tunnels in the hands and feet. Therefore, if your blood sugar is stable, nerve decompression surgery may be a part of your recommended treatment plan. 

Although surgery can’t completely reverse the nerve damage caused by DPN, it can help to alleviate pain and improve function in your feet and hands. Allowing the nerve to recover significantly can lead to improved sensation, better balance, prevention of ulcers, and less pain.   

Now these procedures are not a panacea, and they are not a “get out of jail free” card.  If a patient allows their diabetes to spiral out of control, if a patient chooses to continue to smoke after it has been recommended to stop, or if a patient fails to take their health seriously, these procedures will have a high failure rate.   

Remember, the surgery addresses one problem of the entire complex picture of DPN: we focus on the swollen nerve in the tight tunnel. We also know that the longer the nerve has been affected and the more severe the disease has been, the less likely it becomes that the surgery will work—as the nerves have just been injured too long. It is hard to bring a nerve back from the dead. However, we can help a nerve that is dying if we get there soon enough.

If you’ve been unable to enjoy your favorite activities and spend time with loved ones because of pain from diabetic peripheral neuropathy, contact our office to see if nerve decompression might be an appropriate treatment option. Since 2007, Dr. Eric H. Williams has focused his medical practice on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes, emphasizing nerve injury, entrapment, and diabetic peripheral neuropathy.  

How Does Nerve Decompression Surgery Help Diabetic Neuropathy?

Nerve decompression surgery may be used to treat the symptoms of diabetic neuropathy by relieving pressure on compressed nerves in the extremities. This pressure can be caused by a variety of factors, such as swelling of the nerve in a very tight tunnel, scar tissue, or trauma.

The goal of nerve decompression surgery is to identify and release the compressed nerve or nerves, allowing them to function normally again. This may involve making incisions in the affected area to access the nerve or nerves, followed by the removal of any sources of pressure or irritation, including tight fibrous tissue, and in some cases extra muscles. 

After nerve decompression surgery, you will likely need to limit your activity and wear a protective device or dressing to help protect the surgical site as it heals. Your surgeon may also recommend physical therapy or other rehabilitation exercises to help restore normal function to the affected nerve.

Research has shown that nerve decompression surgery can effectively reduce pain and improve sensation in people with symptoms from diabetic neuropathy, particularly in those with compression of the tibial or common peroneal and lateral femoral cutaneous nerves in the legs and the median and ulnar nerves in the legs or arms. 

However, not all cases of diabetic neuropathy can be improved with nerve decompression, and the effectiveness of nerve decompression surgery may vary depending on the individual case. 

Our Results Speak for Themselves

Our Baltimore surgical practice provides comprehensive care for those who suffer from peripheral nerve injuries, entrapments, and chronic pain or dysfunction. This includes people with nerve pain related to diabetic peripheral neuropathy. If you’d like to learn more about how we’ve helped others like you alleviate the painful symptoms of diabetic neuropathy and get back to making the most of each day, we encourage you to review our patient testimonials. 

For example, Dr. Williams helped a man with a history of diabetic peripheral neuropathy with entrapment of the tibial nerve at the tarsal tunnel as well as the proximal tibial nerve in the calf. The patient had diabetes for three years and struggled with numbness and pain for approximately 10 years. After nerve decompression surgery, he saw substantially reduced numbness, tingling, buzzing, and pain in his toes. Watch this testimonial video to learn more about this patient’s nerve decompression experience. 

Another one of our patients was similarly thrilled with her results just one week out from a tarsal tunnel release and decompression of the medial plantar, lateral plantar, and calcaneal nerves. Her previous care providers told her she had irreversible diabetic neuropathy, so she wondered if she’d simply be expected to live with numbness and pain forever. Then, after seeing Dr. Williams, she found hope for a brighter future. Even though it takes several weeks to see maximum results, she noticed substantial improvement in sensation just one week after her nerve decompression surgery. Watch this testimonial video to learn how nerve decompression helped improve her quality of life. 

 

Diabetic neuropathy is a type of nerve damage that occurs in people with both type 1 and type 2 diabetes. Diabetic neuropathy can affect many organ systems, but this article refers to patients who have tingling, numbness, and pain in the feet and hands. Their symptoms are typically worse in the feet and have been described by some as intense burning, severe pins and needles, feet covered in ants, or walking on barbed wire. Some will complain of numbness and loss of balance. 

Patients tend to ignore these symptoms for long periods of time. Only when their condition is severely affecting their quality of life do they seek out medical attention. 

There are many different medications that have been tried to treat these painful symptoms, and some will be successful. However, research over the past 10 years performed and confirmed by several different teams in several countries has demonstrated that many patients diagnosed with diabetic peripheral neuropathy and treated only with medications also have nerve compressions in the feet and hands. This nerve compression may be the chief cause of their painful symptoms as well as the numbness that occurs. 

We know that decompressing a nerve that is pinched is the best way to treat a compressed nerve. Therefore, one solution for relief for patients suffering from symptoms of diabetic neuropathy might be adding nerve decompression treatment to the other standard treatment measures. However, finding the right physician is vital. You need to work with an experienced peripheral nerve surgeon to create an effective treatment plan to manage your condition and improve your quality of life.

Tips for Finding the Best Doctor for Diabetic Neuropathy

Take the following suggestions into account. Then, you can rest assured that you have the information you need to research professionals capable of providing quality care tailored to your needs.

Ask Your Primary Care Physician for a Referral 

After assessing your condition, your primary care physician can refer you to a specialist with experience in treating diabetic neuropathy pain.  This should include a referral to a peripheral nerve surgeon for evaluation. You may have to ask specifically for this referral as the published research on surgical management is still not widely circulated in the primary care fields, despite 15 years of pioneering research and publications of physicians like Dr. A. Lee Dellon, MD Ph.D.  

Talk to Friends and Family

If you know someone who suffers from pain due to diabetic neuropathy, ask them for a referral, along with what treatment methods were used and the type of results they achieved.

Do Thorough Research

You can search online for doctors in your area who specialize in treating diabetic neuropathy. You can look for peripheral nerve surgeons in your area. Look for physicians who have experience with this condition and positive patient reviews and testimonials. You may even consider watching videos on the doctor’s website to learn how nerve decompression helped other patients manage their neuropathy pain.

Look for Education and Experience

While some physicians might generally treat diabetes for daily management, others provide solutions that require more experience. Dr. Williams is a board-certified plastic surgeon with additional fellowship training in peripheral nerve surgery. He specializes in nerve compression surgery in diabetic patients as well as non-diabetic patients.  

What to Ask Potential Doctors

Once you narrow down the options, schedule in-person appointments with doctors who specialize in treating diabetic neuropathy. At your consultation, here are some key questions to ask: 

• What specific qualifications do you have to treat diabetic neuropathy pain? 
• How long have you been treating patients like me?
• What makes your practice unique and different from others in the area?
• What tests will be done to diagnose my diabetic neuropathy?
• What are the different treatment options for diabetic neuropathy, and which do you recommend for me?
• Who’s an ideal candidate for nerve decompression surgery?
• How successful have treatments such as nerve decompression been for other patients with diabetic neuropathy pain?
• What lifestyle changes can I make to manage my diabetic neuropathy symptoms?
• What are the potential complications of diabetic neuropathy, and how can I prevent them?
• How often should I schedule follow-up appointments to monitor my condition?

The answers each doctor provides and the level of comfort you experience help determine if they’re a good match for you. Remember, to ensure you receive the best possible care, arrive prepared for each appointment with your concerns and ask for specific treatment solutions. Dr. Williams will take the time necessary to address all issues and, after evaluating your individual symptoms and needs, determine the proper course of treatment.

Don’t Deal With Chronic Pain Any Longer

If you’re looking for a doctor to treat diabetic neuropathy, contact Dr. Eric H. Williams today. He’s a peripheral nerve expert who specializes in pain relief and reconstructive surgery, and will thoroughly assess your condition to determine if nerve decompression or another service can provide the relief you need. Find out more by calling our Baltimore office at (410) 709-3868 or by filling out our convenient online contact form.

Diabetic neuropathy is a severe diabetic complication that can cause pain and numbness in your extremities as well as other uncomfortable side effects. There are several different types of the condition, and if left untreated, they might lead to more grave health issues such as organ damage and even amputation. 

Pay attention to the signs of diabetic neuropathy and take action if you suspect you’re affected. The earlier you identify symptoms, the easier it is to address the condition and protect yourself from further complications. For example, to reduce the pain and symptoms associated with different types of diabetic neuropathy, Dr. Williams might recommend nerve decompression to relieve pressure on the affected nerve so you can return to enjoying the activities you once did.

Four Types of Diabetic Neuropathy

Diabetic neuropathy occurs in various parts of the body, and it’s also possible to have more than one affected area and various symptoms. Additionally, for some patients, neuropathy happens gradually over time and isn’t noticeable until nerve damage has occurred.

The four types of diabetic neuropathy are:

• Peripheral. This is the most common condition, which affects the feet and legs first, and then the hands and arms. Symptoms include tingling, numbness, and burning sensations.
• Autonomic. This impacts the autonomic nervous system, which controls involuntary bodily functions such as heart rate, digestion, and bladder control. Symptoms include but aren’t limited to changes in blood pressure, heart rate, and digestive function.
• Proximal. This form of neuropathy occurs primarily in the hips, buttocks, and thighs, presenting symptoms such as pain, weakness, and difficulty moving.
• Mononeuropathy. This type affects a single nerve, most commonly in the face, torso, or leg, with symptoms like sudden weakness or pain in the affected area.

It's important to note that not everyone with diabetes develops neuropathy, and symptoms and severity of the condition vary widely among individuals. But if you’ve had a persistent problem with any of the symptoms outlined above, talk with your primary care provider to determine the underlying cause so the right treatment plan can be developed based on your specific needs. You might also need to consult with another medical specialist to rule out other non-peripheral nerve-related conditions.

Diabetic Neuropathy Treatment Options

If you’re suffering from diabetic nerve pain or other symptoms of neuropathy, such as burning or tingling, nerve decompression surgery may be a potential solution. By undergoing nerve decompression surgery, it’s possible to find relief from these painful symptoms. 

The surgery works by improving blood flow to damaged nerves throughout the body. By increasing circulation and reducing pressure on the nerves, surgeons can successfully reduce pain associated with diabetic neuropathy. Patients often report significant improvements in their quality of life after the surgery. 

Unfortunately, if left untreated, diabetic neuropathy can cause serious problems such as foot ulcers, infection, and amputation. Don’t wait to seek treatment until it’s too late. Dr. Williams can determine if nerve decompression surgery is the right option for you. However, not every person is a candidate for the procedure. Here are some of the key factors that determine your eligibility: 

• Your A1C level must be less than 8.5, and your diabetes must be well-controlled
• A weight of under 350 pounds
• No uncontrolled swelling or restricted blood flow in your feet
• No open or unhealed wounds
• The severity of the nerve damage

Contact Our Baltimore Office Today For Diabetic Neuropathy Questions

If you’re concerned that diabetic neuropathy is affecting your quality of life, contact Dr. Williams today. He specializes in diabetic nerve decompression treatments to help reduce symptoms and increase mobility over time. Find out more by calling our office at 410-709-3868 or filling out our convenient online contact form.

Nerve decompression is a surgical procedure used to relieve pain caused by a compressed nerve in the body. It can be an effective treatment for some people with Type 1 and Type 2 diabetes, but it is important to understand that not everyone will benefit from the surgery. In order to make an informed decision about whether or not nerve decompression is right for you, it is important to discuss your options with your doctor.

Success of Nerve Decompression for Those With Diabetes

Even though nerve decompression can work effectively for some people with Type 1 or Type 2 diabetes, it is not an option for everyone. Those who are ideal candidates for the procedure have symptoms of numbness and tingling, either with or without the presence of pain due to peripheral neuropathy. If there is only pain without numbness or tingling, they may not be a candidate for nerve decompression.

Determining if nerve decompression surgery will be a successful option for you depends on individual factors such as:

• The severity of your nerve damage
• Whether your diabetes is well-controlled and your HgbA1c is less than 8.5
• Weighing under 350 pounds
• Not having uncontrolled swelling or restricted blood flow in your feet or any current open wounds

What to Discuss With Your Doctor Before Diabetic Neuropathy Surgery

Before deciding if nerve decompression surgery is right for you, there are certain things you should discuss with your doctor. These include:

• Your medical history, including any past surgeries
• Any medications you are currently taking, including over-the-counter drugs and prescription medications
• Your current level of physical activity and lifestyle habits
• Risk factors associated with nerve compression surgery, such as anesthesia risks
• Recovery time frame and post-surgical care instructions 
• Potential complications or side effects 

If you are considering nerve decompression surgery, schedule an appointment with Dr. Williams. He can determine if you will benefit from surgery and create a treatment plan to fit your needs. Find out more by contacting our Baltimore office at (410) 709-3868 or by filling out our contact form online.

Related Links: Baltimore Diabetic Peripheral Neuropathy Nerve Compression Relief Why Finding Help for Pain Is Never a Lost Cause Is peripheral nerve surgery safe?

Diabetic nerve pain can be a debilitating condition, causing severe discomfort and making everyday activities like walking or even standing difficult. While medication is often the first course of treatment for diabetic peripheral neuropathy pain, the drugs can have undesirable side effects, such as weight gain and fatigue. If you are suffering from diabetic nerve pain, Dr. Williams can evaluate your condition to determine what treatments other than medication, such as nerve decompression surgery, may be an option for you to consider.

Nerve Decompression for Diabetic Nerve Pain

Nerve decompression is a surgical procedure to free compressed sections of nerves in the body to increase blood flow, allow the nerves to move more freely, and reduce pain caused by compression. This procedure has been shown to be effective for many people suffering from peripheral neuropathy by helping to relieve symptoms of nerve pain and restore mobility and function. If you are looking for an alternative to medication for diabetic nerve pain, speak with Dr. Williams about the possibility of undergoing a nerve decompression procedure.

With the proper treatment, you can regain control over your condition and live a more comfortable, pain-free life. In addition to having Dr. Williams perform nerve decompression surgery, you can do the following to manage symptoms of diabetic peripheral neuropathy:

• Monitoring your blood sugar levels to keep them under control
• Increasing exercise and eating a healthy diet
• Quitting smoking
• Taking good care of your feet

Are You Looking for a Diabetic Nerve Pain Specialist?

If you suffer from diabetic nerve pain and are looking for treatment options other than medication, contact our office for an evaluation. Dr. Williams can determine if nerve decompression surgery is an option for you and will create a treatment plan to help ease your pain and get you back to living pain-free as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.

Related Links: Baltimore Diabetic Peripheral Neuropathy Nerve Compression Relief Is peripheral nerve surgery safe? Peripheral Neuropathy and Trauma