Peripheral Nerve Decompression +Gain of Pedal Sensibility +Balance in PN Patient

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Ann Plast Surg. 2006 Feb;56(2):145-150.

Relationship Between Peripheral Nerve Decompression and Gain of Pedal

Sensibility and Balance in Patients With Peripheral Neuropathy.

Ducic I, NS, Dellon AL.

From the *Department of Plastic Surgery, town University

Hospital, Washington, DC; daggerInstitute for Peripheral Nerve

Surgery, Baltimore, MD; and the double daggerDivision of Plastic

Surgery, s Hopkins University, Baltimore, MD.

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.