{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:02:04Z","timestamp":1781715724829,"version":"3.54.5"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>In 1988, plastic surgeon Lee Dellon in Annals of Plastic Surgery hypothesized that there was \u201cA Cause for Optimism in Diabetic Neuropathy\u201d. He noted that entrapment neuropathy is common in diabetic peripheral neuropathy (DPN) and explained that multiple sites of local nerve entrapment can also produce the classically described clinical picture of progressive and irreversible \u2018length dependent axonopathy\u2019. This observation has justified for him the use of nerve decompression (ND) surgery for beneficial treatment of DPN pain, diabetic foot ulcer (DFU), ulcer recurrences and their subsequent complications. Subsequent observational and controlled reports have consistently demonstrated post-operative benefit for these problems, but ND has not yet been widely adopted. The lack of an etiologic explanation of the physiology changes which would allow surgery to modify the metabolic disturbances of diabetes has likely been involved in such hesitance. Recent explanations that glycolysis is altered in diabetes through intensified polyol metabolism which produces swollen nerves, local peripheral entrapments and compression neuropathy now provide plausible associations of hyperglycemia with epidermal hypoxia and nutrition deficit. Recognition that nerve enlargements can create secondary fibro-osseous compressions explains the well-known association of diabetes and compression syndromes. Peripheral nerve entrapments damage small c-fibers and produce sympathetic autonomic as well as sensorimotor dysfunction. This explains the diminished skin microcirculation, epidermal hypoxia and nutrition deficit seen in diabetes, DPN, DFU and Charcot neuroarthropathy. Laboratory and clinical evidence has demonstrated that ND in diabetes rejuvenates at least two sympathetically commanded skin microcirculation processes and explains how surgery is producing beneficial results. This article recapitulates the literature which clarifies the processes by which ND surgery can modify painful DPN, DFU occurrence, ulcer healing, DFU recurrence risk, amputations after DFU healing, and bilateral pain relief after unilateral surgery.<\/jats:p>","DOI":"10.3390\/japma116030037","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:11:22Z","timestamp":1781709082000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reconsidering Nerve Decompression Surgery in Diabetes Foot Complications"],"prefix":"10.3390","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0842-7362","authenticated-orcid":false,"given":"D. Scott","family":"Nickerson","sequence":"first","affiliation":[{"name":"Northeast Wyoming Wound Clinic, 1401 W. 5th St., Sheridan, WY 82801, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/wrr.12328","article-title":"High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes","volume":"23","author":"Apelqvist","year":"2015","journal-title":"Wound Repair Regen."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/wrr.12522","article-title":"Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer","volume":"25","author":"Apelqvist","year":"2017","journal-title":"Wound Repair. Regen."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/S1474-4422(22)00188-0","article-title":"Towards prevention of diabetic peripheral neuropathy: Clinical presentation, pathogenesis, and new treatments","volume":"21","author":"Elafros","year":"2022","journal-title":"Lancet Neurol."},{"key":"ref_4","unstructured":"Srikanth, K.K., and Orrick, J.A. (2024). Biochemistry, Polyol or Sorbitol Pathways, Publishing LLC."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/1938640020905423","article-title":"Ultrasound-Guided Proximal and Distal Tarsal Decompression: An Analysis of Pressures in the Tarsal, Medial Plantar, and Lateral Plantar Tunnels","volume":"14","author":"Marcos","year":"2021","journal-title":"Foot Ankle Spec."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/S0300-595X(86)80079-2","article-title":"The diabetic foot: Pathophysiology and treatment","volume":"15","author":"Edmonds","year":"1986","journal-title":"Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1464-5491.1986.tb00708.x","article-title":"Autonomic neuropathy and diabetic foot ulceration","volume":"3","author":"Edmonds","year":"1986","journal-title":"Diabet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/BF00250890","article-title":"Sympathetic nerve failure in diabetes","volume":"25","author":"Watkins","year":"1983","journal-title":"Diabetologia"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/s001250050923","article-title":"Pronounced skin capillary ischemia in the feet of diabetic patients with bad metabolic control","volume":"41","author":"Brismar","year":"1998","journal-title":"Diabetologia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"669e","DOI":"10.1097\/PRS.0000000000006090","article-title":"A Systematic Review and Meta-Analysis of the Pressure-Induced Vasodilation Phenomenon and Its Role in the Pathophysiology of Ulcers","volume":"144","author":"Zwanenburg","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Balasubramanian, G., Vas, P., Chockalingam, N., and Naemi, R. (2020). A Synoptic Overview of Neurovascular Interactions in the Foot. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00308"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1089\/wound.2023.0199","article-title":"Objective Evidence That Nerve Decompression Surgery Reduces Neuropathic DFU Recurrence Risk to Less than 5%","volume":"13","author":"Nickerson","year":"2024","journal-title":"Adv. Wound Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e70198","DOI":"10.1111\/iwj.70198","article-title":"Improving Microcirculation With Nerve Decompression: The Missing Link in Treatment of Diabetic Neuropathy and Diabetic Foot Ulcer","volume":"22","author":"Nickerson","year":"2025","journal-title":"Int. Wound J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.bjps.2025.01.058","article-title":"Dellon decompression of the tarsal tunnel: An effective approach to improving blood flow, promoting ulcer healing and recovery of sensibility in diabetic patients","volume":"103","author":"Pejkova","year":"2025","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic Foot Ulcers and Their Recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e3160","DOI":"10.1002\/dmrr.3160","article-title":"Global recurrence rates in diabetic foot ulcers: A systematic review and meta-analysis","volume":"35","author":"Fu","year":"2019","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_17","first-page":"CD006152","article-title":"Decompressive surgery of lower limbs for symmetrical diabetic peripheral neuropathy","volume":"2011","author":"Chaudhry","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1212\/01.wnl.0000219631.89207.a9","article-title":"Practice Advisory: Utility of surgical decompression for treatment of diabetic neuropathy: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"66","author":"Chaudhry","year":"2006","journal-title":"Neurology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"421","DOI":"10.2337\/dc06-2324","article-title":"Surgical decompression for diabetic sensorimotor polyneuropathy","volume":"30","author":"Cornblath","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e3269","DOI":"10.1002\/dmrr.3269","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Bus","year":"2020","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/SLA.0000000000006228","article-title":"Effect of Lower Extremity Nerve Decompression in Patients with Painful Diabetic Peripheral Neuropathy: The DNND Randomized, Observation Group- and Placebo Surgery-controlled Clinical Trial","volume":"280","author":"Rozen","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/00000637-198802000-00001","article-title":"A cause for optimism in diabetic neuropathy","volume":"20","author":"Dellon","year":"1988","journal-title":"Ann. Plast. 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