Neuropathy literally means "disease of the nerve" in Greek. The nerve can be become diseased in several different ways, generally causing similar symptoms including numbness, tingling and often burning pain.
Often, neuropathy patients are told by their medical doctor that they have to live with the disease, that they should take something for the burning pain and that nothing can be done for them. Too often, treatable options are not explored, patients eventually lose sensation in their feet and frequently suffer the consequences by developing ulcers, followed by toe and foot amputations.
At the Swier Clinic we have a different approach. We do a thorough investigation to find the cause of the nerve dysfunction and whether it can be reversed with surgery.
Numbness, tingling and burning pain are caused by dysfunction of the nerve and can be caused by one or several of the following reasons:
- demyelination of the nerve sheath: the insulating material around the nerve can break down as in multiple sclerosis, Charcot-Marie-Tooth or CMT, and vitamin B6 or 12 deficiency
- development of abcesses inside the nerve as in leprosy
- vasculitis or inflammation of the blood vessels in the nerve sheath causing lack of blood supply or oxygen delivery to the nerve, as in rheumatoid arthritis and scleroderma
- compression of the nerve in the neck or back: a herniated disc, most commonly, in the neck or back or spinal stenosis can interfere with nerve impulses travelling down the spinal cord and cause weakness and numbness
- trauma to the nerve from an accident in a car or at work or from from another surgery can cause the nerve to get caught in scar tissue, or be simply cut or crushed
- compression of the nerve in the arms and legs where the nerve travels through an area that is narrowed. Swelling of the nerve from diabetes, chemotherapy or repetitive trauma can cause the nerve to swell and get stuck in this area of narrowing. This will cause a lack of blood supply to the nerve and eventually will cause this area of the nerve to die.
Only peripheral nerve compression can be improved with surgery. These surgeries are typically short (1–1.5 hours) outpatient procedures performed in a surgery center with some sedation. They were pioneered by Dr. A. Lee Dellon, with whom Dr. Swier spent a year following his residency at Johns Hopkins. Studies at the Mayo Clinic and other institutions have since validated these procedures (see bibliography). The recovery following these procedures is similar to that with other procedures on the feet and includes limited walking and foot elevation. Most patients immediately notice a relief in the tingling and burning pain while the numbness takes longer to improve. It can take up to 1–2 years until the nerves have fully recovered and sensation is restored. In most series the amputation rate is 0% following these peripheral nerve releases, and therefore it appears to be an excellent way to prevent amputations in the lower extremities.