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Diabetic neuropathy is a loss of sensory and motor function in the hands and feet of people with diabetes. While there are several different types of neuropathy that may occur in diabetics, the most common one effects the feet first and subsequently the hands. The individual begins to notice sensory changes such as numbness, pain or tingling in the toes or fingers. At first these symptoms will come and go, but then they will become constant. The unpleasant symptoms may interfere with your going to sleep, or may cause you to awaken from sleep. Over time, with increasing loss of sensation, you may not be able to feel how tight your shoes are, know whether the bath water is hot or cold, or feel any small injuries to your feet. Changes in muscle strength may also occur. This weakness may cause you to feel unstable on your feet or to fall and the arches in your feet may collapse.

Neuropathy is the leading cause of ulcerations (wounds) that occur on the feet. Neuropathy is the leading cause of infections in the feet. Neuropathy is the leading cause of loss of toes and in advanced cases, amputation of the lower leg.

The reason that diabetic's nerves are susceptible to compression is that the nerves in diabetic's are swollen. Sugar from the blood enters into the nerve to give the nerve energy; this glucose is converted into another sugar called sorbitol. Sorbitol's chemical formula makes it attract water molecules. When water is drawn into the nerve, the nerves can become swollen. When nerves become swollen, they can become pinched or compressed at areas of tight fibrous bands in the lower and upper extremities. This compression causes the symptoms of neuropathy; such as carpal tunnel syndrome.

A second reason for the neuropathy is that the transport system for nutrients for the nerve is slowed in a diabetic. This decrease in axoplasmic transport means that the nerve cannot repair itself well, rendering it more likely to remain in trouble from compression and therefore produce symptoms of neuropathy.

Although good control of blood glucose levels can slow the development of neuropathy, doctors today still do not have a medical approach to either prevent or control the progressive loss of sensory and motor functions. There are medications to treat the symptoms of neuropathy, but the underlying pathology is not improved.

Dr. Lee Dellon has developed a noninvasive testing method to quantitate the degree of sensory nerve loss in both upper and lower extremities. He has also developed a surgical intervention to decompress the peripheral nerves of the lower extremities to help restore sensory and motor function. To date, Dr. Dellon and those surgeons that he has trained have either decreased or completely alleviated neuropathic symptoms in 80% of the diabetics which they have treated. To date, no patient that has had a peripheral nerve decompression has developed an ulceration on the lower extremity.

 

Wound Care Clinic @ AJH

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plastic surgeryView Dr. Sasmor's video on Diabetic Peripheral Neuropathy
 

 

Other useful sites:
www.dellon.com

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View Brochure (PDF)

If you have been referred to have neurosensory testing with a special machine called the pressure-specified sensory device (PSSD), a test with this machine will quantify the loss of sensation in your lower extremities. Evaluation of this test result will determine whether you are a candidate for nerve release surgery to help decrease or completely alleviate these symptoms of your neuropathy.

The test results will be evaluated by Dr. Michele Sasmor of RiverSong Plastic Surgery, and Dr. Michael Wack of Seacoast Orthopedics. These three surgeons have been trained to do the nerve release surgery by Dr. Dellon. That surgery can be performed at Anna Jaques Hospital. You will be notified after your sensory test whether you are a potential candidate for surgery and an appointment can be set up with Dr. Sasmor or Dr Wack for surgical evaluation should you choose.

PSSD Testing / Nerve Release

Neurosensory Testing with the Pressure-Specified Sensory Device (TM):

  • Measures cutaneous pressure threshold, static and moving one-and two-point discrimination.
  • Uses state-of-the-art, FDA cleared, computer-assisted devices.
  • Allows for follow-up testing at regular intervals.
  • Measurements are traceable to the National Institute of Standards and Technology.
  • A computer-based sensory testing system with user friendly software:
    -Full testing and screen testing modes
    -Prints well documented patient reports
  • No electrical stimulation

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Newburyport Office
Anna Jaques Hospital
Suite 3-4A
21 Highland Avenue
Newburyport, MA 01950
P 978.462.8300
F 978.462.8301

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