{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:51:43Z","timestamp":1792183903692,"version":"4.4.0"},"reference-count":36,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":2755,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>It has been hypothesized that the development of diabetic polyneuropathy (DPN) is due to swelling of the nerve, as well as thickening and stiffening of the surrounding ligaments, causing chronic compression of nerves. We aimed to examine the effect of surgical decompression of the tibial nerve on the mean cross-sectional area (CSA).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We performed a randomized controlled trial of 42 subjects with painful DPN diagnosed using the Diabetic Neuropathy Score. A computer randomized for the surgery arm of the study. A control group consisting of 38 healthy subjects was included. An experienced sonographer measured the CSA and thickness-to-width (T\/W) ratio of the tibial nerve, as well as the thickness of the flexor retinaculum.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>CSA is significantly larger in patients with painful DPN (8.4 \u00b1 3.9 mm2) than in control subjects (6.4 \u00b1 1.3 mm2), P = 0.007. The T\/W ratio in patients with painful DPN is 0.64 and in control subjects 0.59, P = 0.03. Patients with DPN have a significantly thicker retinaculum (1.07 mm) than control subjects (0.84 mm), P &amp;lt; 0.001. Mean follow-up was 28.2 weeks (range 23\u201345). Difference between baseline and follow-up in the operated leg was 1.49 mm2 and in the control leg 1.81 mm2, P = 0.674.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Decompression of the tibial nerve does not result in a significant difference between baseline and follow-up in CSA using ultrasound between the operated and control leg. Ultrasound measurements show a significantly increased CSA, a significantly thicker retinaculum, and a significantly increased T\/W ratio in patients with painful DPN compared with healthy control subjects.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc13-1787","type":"journal-article","created":{"date-parts":[[2014,1,2]],"date-time":"2014-01-02T06:23:14Z","timestamp":1388643794000},"page":"767-772","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":24,"title":["Ultrasound Findings After Surgical Decompression of the Tarsal Tunnel in Patients With Painful Diabetic Polyneuropathy: A Prospective Randomized Study"],"prefix":"10.2337","volume":"37","author":[{"given":"Joanne F.M.","family":"Macar\u00e9 van Maurik","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marita E.L.","family":"Schouten","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Medical Center Utrecht, Utrecht University Faculty of Medicine, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"ten Katen","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireille","family":"van Hal","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar J.G.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Medicine, VU University Medical Center, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moshe","family":"Kon","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2014,2,11]]},"reference":[{"key":"2022031219531501300_B1","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S1474-4422(12)70065-0","article-title":"Diabetic neuropathy: clinical manifestations and current treatments","volume":"11","author":"Callaghan","year":"2012","journal-title":"Lancet Neurol"},{"key":"2022031219531501300_B2","doi-asserted-by":"crossref","first-page":"ii15","DOI":"10.1136\/jnnp.74.suppl_2.ii15","article-title":"The diabetic neuropathies: types, diagnosis and management","volume":"74","author":"Llewelyn","year":"2003","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2022031219531501300_B3","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1097\/00006534-199204000-00018","article-title":"Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves","volume":"89","author":"Dellon","year":"1992","journal-title":"Plast Reconstr Surg"},{"key":"2022031219531501300_B4","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.ultrasmedbio.2011.04.004","article-title":"Epidermal thickness and biomechanical properties of plantar tissues in diabetic foot","volume":"37","author":"Chao","year":"2011","journal-title":"Ultrasound Med Biol"},{"key":"2022031219531501300_B5","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1016\/j.apmr.2011.03.015","article-title":"Changes in the thickness and stiffness of plantar soft tissues in people with diabetic peripheral neuropathy","volume":"92","author":"Sun","year":"2011","journal-title":"Arch Phys Med Rehabil"},{"key":"2022031219531501300_B6","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.2337\/diacare.26.5.1525","article-title":"Contribution of plantar fascia to the increased forefoot pressures in diabetic patients","volume":"26","author":"D\u2019Ambrogi","year":"2003","journal-title":"Diabetes Care"},{"key":"2022031219531501300_B7","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/00006534-200009020-00010","article-title":"Results of decompression of peripheral nerves in diabetics: a prospective, blinded study","volume":"106","author":"Aszmann","year":"2000","journal-title":"Plast Reconstr Surg"},{"key":"2022031219531501300_B8","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/00000658-199506000-00005","article-title":"Treatment of hyperesthetic neuropathic pain in diabetics. 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