Dr. Damien M. Dauphinée has spent his entire career in podiatric foot and ankle surgery treating diabetic patients who are at risk for limb loss. There are over 16 million diabetic patients in the United States today. Almost everyone has a family member or friend who has been touched by this disease. Diabetic patients make up the largest population of amputees not caused by trauma. The main reason diabetic patients lose limbs is diabetic neuropathy or the progressive loss of sensation in the lower extremities.
"Unfortunately, even with your blood sugar in good control, neuropathy may occur," says Dr. Dauphinée. "In fact, over time, this will occur in 50% - 70% of diabetics. Once diabetic neuropathy occurs, it almost always gets worse. Currently, there is no agreement on why it occurs, and there is no medical treatment to prevent it," he adds.
While there are several different types of neuropathy that may occur in diabetics, the most common one affects the feet first and then the hands. Usually, one will have begun to notice sensory changes, such as numbness or tingling in the fingers or toes. At first, these symptoms may interfere with sleep, or cause one to awaken from sleep. Over a long period of time, these sensory disturbances may cause such a loss of sensibility that one will not feel how tight their shoes are, or know whether the bath water is hot or cold. Changes in muscle strength also occur. In the feet, the weakness may cause diabetics to fall and the arches in their feet to collapse. In the hands, one may notice a problem opening jars, turning a key in a lock, loss of coordination, and dropping objects.
Neuropathy is the leading cause of the ulcerations or holes that occur in the feet. Neuropathy is the leading cause of infections in the feet. Neuropathy is the leading cause of the loss of toes and, with advanced cases, amputation.
There may be some optimism for patients with diabetes. By having a yearly measurement made of the sensibility in your hands and feet, the earliest stages of neuropathy can be identified and appropriate changes in your diabetes management can be made. In certain circumstances, it may be found that areas are present in both your arms and legs that cause compression of your nerves. These sites of pressure on your nerves can be treated with surgery in order to restore sensation to your hands and feet.
"I have spent the last several years studying diabetic neuropathy and the available treatment options. This led me to seek additional surgical training in peripheral nerve surgery with surgeons from Johns Hopkins Medical School," says Dr. Dauphinée. "These surgeons have developed surgical procedures designed to restore sensation and reduce or eliminate the burning and tingling pain," adds Dr. Dauphinée.
Nerves begin in the spinal cord and extend into the fingers and toes. Along this path there are anatomic areas of narrowing. These exist in everyone and many are already known to you, such as your "funny bone" at the elbow and the carpal tunnel at the wrist. In the leg, there are similar tight places at the outside of your knee and the inside of your ankle, called the tarsal tunnel. Although some people may have been born with structures that would make the tunnels more narrow and the nerves more likely to become pinched, like a smaller wrist or extra muscles that go through one of these tunnels, the diabetic has two unique reasons to make nerves susceptible to compression. Firstly, diabetics may develop swollen nerves due to the high blood sugars. Secondly, these swollen nerves travel through tight tunnels that are stiffening over time, also due to the high blood sugars. The combination of these effects can create severe compression points on specific peripheral nerves.
You will feel buzzing, tingling or numbness in the areas that are supplied by that nerve. In the foot, the problem similar to carpal tunnel syndrome is called tarsal tunnel syndrome. It involves compression of the posterior tibial nerve in the bony tunnel on the inside of the ankle. This nerve supplies the entire bottom of the foot, including the heel. Compression of the posterior tibial nerve can result in numbness or tingling of the heel, the arch, the ball of the foot, and the bottom and tips of the toes. The loss of sensation in the feet can cause a loss of balance, a feeling of unsteadiness, and cause you to fall.
The surgery to decompress the nerve does not change the basic, underlying metabolic (diabetic) neuropathy that made the nerve susceptible to compression in the first place. When the surgical decompression is done early in the course of nerve compression, restoration of blood flow to the nerve will stop the numbness and tingling, and permit strength to recover. When the decompression is done later in the course of nerve compression, and nerve fibers have begun to die, decompression of the nerve will permit the diabetic nerve to regenerate.
Bachelor of Science
University of Notre Dame
Doctorate in Podiatric Medicine
Dr. William M. Scholl College of Podiatric Medicine
Fellow of the American College of Foot and Ankle Surgeons Fellow of the Association of Extremity Nerve Surgeons
Three years of surgical residency training in Reconstructive Foot and Ankle Surgery: