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Relationship between peripheral nerve decompression and gain of pedal sensibility and balance in patients with peripheral neuropathy.

Dr. Alan Shih
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Ducic I, Taylor NS, Dellon AL.

This was an initial exploratory study to determine if decompression of the 4 medial ankle tunnels (neurolysis of the tibial, medial and lateral plantar, and calcaneal nerves) could lead to improved foot sensibility, increased proprioception and balance, and decreased falls in a population of patients with impaired lower extremity sensation. Fourteen patients with peripheral neuropathy were included in this study. Seventy-one percent of patients were females. Average age was 67 years. All patients were evaluated preoperatively and postoperatively to assess their lower extremity sensibility, as well as their ability to stand still, maintaining their balance with their eyes open and then closed, which is defined as "sway." Lower extremity sensibility was measured with the Pressure-Specified Sensory Device (PSSD), which evaluates 1- and 2-point discrimination for the pulp of the big toe and medial heel. The MatScan Measurement System measured each patient's sway. Neuropathy was the result of diabetes in 72% of patients, a combination of diabetes and hypothyroidism in 7%, chemotherapy in 7%, and idiopathic in 14%. Eight patients underwent peripheral nerve decompression on 1 lower extremity, whereas 6 patients underwent bilateral lower extremity peripheral nerve decompression. Mean toe and heel sensibility improved 9% and 7%, respectively, in the unilateral group, whereas the bilateral group experienced an improvement in mean toe and heel sensibility of 42% (P = 0.02) and 32%, respectively. Preoperative and postoperative sway comparison in the unilateral group revealed a reduction in sway with eyes open and eyes closed by 5% and 31%, respectively. Comparison of preoperative and postoperative sway in the bilateral group showed a reduction with eyes open and eyes closed by 23% and 145% (P = 0.05), respectively. This initial study suggests that there may be benefit from bilateral lower extremity peripheral nerve decompression in helping improve pedal sensibility and balance within the peripheral neuropathy patient population, although further investigation with a larger sample size is warranted to further evaluate these preliminary findings.

Ann Plast Surg. 2006 Feb;56(2):145-50.