Treatment of hyperesthetic neuropathic pain in diabetics. Decompression of the tarsal tunnel.

OBJECTIVE: The authors evaluated the causal relationship between entrapment of the posterior tibial nerve and neuropathic pain and describe the results of nerve decompression in a selected group of patients with intractable pain.

SUMMARY BACKGROUND DATA: Painful metabolic neuropathy has, until recently, been thought to be an irreversible and essentially untreatable complication of diabetes. Recent studies have shown that metabolic deterioration is only one component of the disease process.

METHODS: A group of patients with intractable painful neuropathy and a positive percussion sign underwent posterior tibial nerve decompression.

RESULTS: Nerve decompression relieved the pain in the majority of treated patients. Return of other sensory function also was noted.

CONCLUSIONS: Painful diabetic neuropathy of the lower extremities is potentially reversible. It appears to be caused partially by nerve entrapment and can be reversed by decompression.