Surgical Decompression in the Management of Lower Extremity Diabetic Peripheral Neuropathy: A Narrative Review
Main Article Content
Abstract
Diabetic peripheral neuropathy commonly develops in patients with diabetes mellitus. Standard medical treatments help a minority of patients with the amelioration of pain, but do not modify the course of the illness. Treatment of diabetic peripheral neuropathy with surgical decompression of lower extremity nerves is controversial. However, the surgery has the potential to ameliorate pain and to improve quality of life in patients suffering with painful neuropathy; it also has the potential to modify the course of the disease, improving protective sensation of the skin of the foot, decreasing the probability of ulcer formation and subsequent amputation. This review will briefly look at the etiology of diabetic peripheral neuropathy and the rationale for nerve decompression surgery as a treatment option. Surgery for upper extremity nerves, and diagnostic criteria will be followed by an examination of the evidence published to date on the validity of nerve decompression surgery in the treatment of diabetic neuropathy.
Article Details
How to Cite
BEST, Timothy J..
Surgical Decompression in the Management of Lower Extremity Diabetic Peripheral Neuropathy: A Narrative Review.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6851>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6851.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Pop-Busui R, Boulton AJ, Feldman EL, et. al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017; 40:136-154.
3. Ang L, Mizokami-Stout K, Eid SA, et al. The conundrum of diabetic neuropathies—past, present, and future. J. Diabetes Complications. 2022; 36:108334.
4. Braffett BH, Gubitosi-Klug RA, Albers JW, et al. Risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes 2020;69:1000–10.
5. Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996;39:1377–84.
6. Mizokami-Stout KR, Li Z, Foster NC, et al. The contemporary prevalence of diabetic neuropathy in type 1 diabetes: findings from the T1D Exchange. Diabetes Care 2020;43:806–12.
7. Ziegler D, Rathmann W, Dickhaus T, et al. Prevalence of Polyneuropathy in Pre-Diabetes and Diabetes Is Associated With Abdominal Obesity and Macroangiopathy: The MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care 2008;31:464–69.
8. Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of type 1 diabetes versus type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA 2017;317:825–35.
9. Zhang Y, Lazzarini PA, McPhail SM, et al. Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care 2020; 43:964-974.
10. Lazzarini PA, Pacella RE, Armstrong DG, et al.Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med 2018; 35:1297-1299.
11. Armstrong DG, Tan TW, Boulton AJM et al. Diabetic foot ulcers: a review. JAMA 2023; 330:62-75.
12. Savelieff, MG, Elafros, MA, Viswanathan, V, et al. The global and regional burden of diabetic peripheral neuropathy. Nat Rev Neurol 2024;1:17–31.
13. Sorber R, Abularrage CJ. Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. Semin Vasc Surg 2021;34(1):47-53.
14. Beyaz S, Güler ÜÖ, Bağır GŞ. Factors affecting lifespan following below-knee amputation in diabetic patients. Acta Orthop Traumatol Turc. 2017;51(5):393-397.
15. Van Acker K, Bouhassira D, De Bacquer D, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206-13.
16. Geelen CC, Smeets RJEM, Schmitz S, et al. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. Eur J Pain. 2017;21(10):1632-1641.
17. Naranjo C, Del Reguero L, Moratalla G. et al. Anxiety, depression and sleep disorders in patients with diabetic neuropathic pain: a systematic review. Expert Rev Neurother. 2019;19(12), 1201–1209.
18. Cengiz EK, Firat YE, Karsidag S, et al. Associations between stages of diabetic polyneuropathy and quality of life, neuropathic pain, and well-being: A multicenter, cross-sectional analysis based on electroneuromyographic findings. Neurophysiol Clin. 2025;55(1):103025.
19. Obrosova IG, Kador PF. Aldose reductase/polyol inhibitors for diabetic retinopathy. Curr Pharm Biotechnol. 2011;12(3):373-85.
20. Qureshi Z, Ali MN, Khalid M. An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy. J Diabetes Res. 2022;2022:9989272.
21. Ahmad S, Ahmad MFA, Khan S, et al. Exploring aldose reductase inhibitors as promising therapeutic targets for diabetes-linked disabilities. Int J Biol Macromol. 2024;280(Pt 2):135761.
22. Riazi S, Bril V, Perkins, BA et al. Can Ultrasound of the Tibial Nerve Detect Diabetic Peripheral Neuropathy?: A cross-sectional study. Diabetes Care 2012; 35 (12): 2575–2579.
23. Singh K, Gupta K, Kaur S. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy. J Ultrason. 2017; 17: 246-252.
24. Breiner A, Qrimli M, Ebadi H, et al. Peripheral nerve high-resolution ultrasound in diabetes. Muscle Nerve. 2017;55(2):171-178.
25. Telleman JA, Grimm A, Goedee S, et al. Nerve ultrasound in polyneuropathies. Muscle Nerve. 2018; 57: 716-728.
26. Dhanapalaratnam R, Issar T, Poynten AM, et al. Diagnostic accuracy of nerve ultrasonography for the detection of peripheral neuropathy in type 2 diabetes. Eur J Neurol. 2022;29(12):3571-3579.
27. Dellon AL. A cause for optimism in diabetic neuropathy. Ann Plast Surg. 1988;20(2):103-5.
28. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2(7825):359–362.
29. Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992;89(4):689-97.
30. Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004;53(6):517-22.
31. Sayed D, Deer T R, Hagedorn JM., et al. A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET. J Pain Res 2024;17, 1461–1501.
32. Qureshi Z, Ali MN, Khalid M. An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy. J Diabetes Res. 2022;9989272.
33. Hernando-Garijo I, Medrano-de-la-Fuente R, Mingo-Gomez MT, et al. Effects of exercise therapy on diabetic neuropathy: A systematic review and meta-analysis. Physiother Theory Pract 2024;40(9):2116-2129.
34. Yang K, Wang Y, Li Y, et al. Progress in the treatment of diabetic peripheral neuropathy. Biomed Pharm 2022; 148:112717.
35. Zimmerman M, Dahlin E, Thomsen NOB, et al. Outcome after carpal tunnel release: impact of factors related to metabolic syndrome. J Plast Surg Hand Surg. 2017;51(3):165-171.
36. Moradi A, Sadr A, Ebrahimzadeh MH, Hassankhani GG, Mehrad-Majd H. Does diabetes mellitus change the carpal tunnel release outcomes? Evidence from a systematic review and meta-analysis. J Hand Ther. 2020;33(3):394-401.
37. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44:597–607
38. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-9.
39. Billig JI, Kotsis SV, Ouyang Z, Wang L, Chung KC. A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg. 2022;150(6):1287-1296.
40. Shapiro LM, Kamal RN. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome. J Am Acad Orthop Surg. 2025;33(7):e356-e366.
41. Graham B., Regehr G., Naglie G., Wright J.G.: Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006 Jul-Aug; 31: pp. 919-924.
42. Grandizio LC, Ozdag Y, Mettler AW, et al. Sensitivity, Specificity, and Reliability of the CTS-6 for Carpal Tunnel Syndrome Administered by Medical Assistants. J Hand Surg Am. 2024;49(7):656-662.
43. Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27(7):1783-8.
44. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-62.
45. Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes. 2016;7(17):342-353.
46. Tannemaat MR, Datema M, van Dijk JG, Midha R, Malessy MJ. Decompressive Surgery for Diabetic Neuropathy: Waiting for Incontrovertible Proof. Neurosurgery. 2016;79(6):783-785.
47. Diabetes Canada Clinical Practice Guidelines Expert Committee, Bril V, Breiner A, Perkins BA, Zochodne D (2018) Neuropathy. Can J Diabetes 42 Suppl 1: S217–S221
48. Atmaca A, Ketenci A, Sahin I, et al. Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach. Front Endocrinol (Lausanne). 2024;15:1380929.
49. Gad H, Kalra S, Pinzon R, et al. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst. 2024;29(1):28-37.
50. Rozen SM, Wolfe GI, Vernino S, et al. Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial. Ann Surg. 2024;280(1):35-45.
51. Beard DJ, Campbell MK, Blazeby JM, et al. Considerations and methods for placebo controls in surgical trials (ASPIRE guidelines). Lancet. 2020;395(10226):828-838.
52. Best TJ, Best CA, Best AA, Fera LA. Surgical peripheral nerve decompression for the treatment of painful diabetic neuropathy of the foot - A level 1 pragmatic randomized controlled trial. Diabetes Res Clin Pract. 2019;147:149-156.
53. van Maurik JFMM, van Hal M, van Eijk RPA, Kon M, Peters EJG. Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial. Plast Reconstr Surg. 2014;134(2):325-332.
54. Rinkel WD, de Kleijn JL, Macaré van Maurik JFM, Coert JH. Optimization of Surgical Outcome in Lower Extremity Nerve Decompression Surgery. Plast Reconstr Surg. 2018;141(2):482-496.
55. Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992;89(4):689-9
56. Aszmann OC, Kress KM, Dellon AL. Results of decompression of peripheral nerves in diabetics: a prospective, blinded study. Plast Reconstr Surg. 2000;106(4):816-22.
57. Wieman TJ, Patel VG. Treatment of hyperesthetic neuropathic pain in diabetics. Decompression of the tarsal tunnel. Ann Surg. 1995;221(6):660-4; discussion 664-5.
58. Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004;53(6):517-22.
59. Fadel ZT, Imran WM, Azhar T. Lower Extremity Nerve Decompression for Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(8):e4478.
60. Louca M, Meares C, Dusseldorp JR. Decompressive Nerve Surgery Associated with Low Diabetic Foot Ulcer Rate and High-Risk Bias: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2025;155(4):809e-820e.
2. Pop-Busui R, Boulton AJ, Feldman EL, et. al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017; 40:136-154.
3. Ang L, Mizokami-Stout K, Eid SA, et al. The conundrum of diabetic neuropathies—past, present, and future. J. Diabetes Complications. 2022; 36:108334.
4. Braffett BH, Gubitosi-Klug RA, Albers JW, et al. Risk factors for diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes 2020;69:1000–10.
5. Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996;39:1377–84.
6. Mizokami-Stout KR, Li Z, Foster NC, et al. The contemporary prevalence of diabetic neuropathy in type 1 diabetes: findings from the T1D Exchange. Diabetes Care 2020;43:806–12.
7. Ziegler D, Rathmann W, Dickhaus T, et al. Prevalence of Polyneuropathy in Pre-Diabetes and Diabetes Is Associated With Abdominal Obesity and Macroangiopathy: The MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care 2008;31:464–69.
8. Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of type 1 diabetes versus type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA 2017;317:825–35.
9. Zhang Y, Lazzarini PA, McPhail SM, et al. Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care 2020; 43:964-974.
10. Lazzarini PA, Pacella RE, Armstrong DG, et al.Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med 2018; 35:1297-1299.
11. Armstrong DG, Tan TW, Boulton AJM et al. Diabetic foot ulcers: a review. JAMA 2023; 330:62-75.
12. Savelieff, MG, Elafros, MA, Viswanathan, V, et al. The global and regional burden of diabetic peripheral neuropathy. Nat Rev Neurol 2024;1:17–31.
13. Sorber R, Abularrage CJ. Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. Semin Vasc Surg 2021;34(1):47-53.
14. Beyaz S, Güler ÜÖ, Bağır GŞ. Factors affecting lifespan following below-knee amputation in diabetic patients. Acta Orthop Traumatol Turc. 2017;51(5):393-397.
15. Van Acker K, Bouhassira D, De Bacquer D, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206-13.
16. Geelen CC, Smeets RJEM, Schmitz S, et al. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. Eur J Pain. 2017;21(10):1632-1641.
17. Naranjo C, Del Reguero L, Moratalla G. et al. Anxiety, depression and sleep disorders in patients with diabetic neuropathic pain: a systematic review. Expert Rev Neurother. 2019;19(12), 1201–1209.
18. Cengiz EK, Firat YE, Karsidag S, et al. Associations between stages of diabetic polyneuropathy and quality of life, neuropathic pain, and well-being: A multicenter, cross-sectional analysis based on electroneuromyographic findings. Neurophysiol Clin. 2025;55(1):103025.
19. Obrosova IG, Kador PF. Aldose reductase/polyol inhibitors for diabetic retinopathy. Curr Pharm Biotechnol. 2011;12(3):373-85.
20. Qureshi Z, Ali MN, Khalid M. An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy. J Diabetes Res. 2022;2022:9989272.
21. Ahmad S, Ahmad MFA, Khan S, et al. Exploring aldose reductase inhibitors as promising therapeutic targets for diabetes-linked disabilities. Int J Biol Macromol. 2024;280(Pt 2):135761.
22. Riazi S, Bril V, Perkins, BA et al. Can Ultrasound of the Tibial Nerve Detect Diabetic Peripheral Neuropathy?: A cross-sectional study. Diabetes Care 2012; 35 (12): 2575–2579.
23. Singh K, Gupta K, Kaur S. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy. J Ultrason. 2017; 17: 246-252.
24. Breiner A, Qrimli M, Ebadi H, et al. Peripheral nerve high-resolution ultrasound in diabetes. Muscle Nerve. 2017;55(2):171-178.
25. Telleman JA, Grimm A, Goedee S, et al. Nerve ultrasound in polyneuropathies. Muscle Nerve. 2018; 57: 716-728.
26. Dhanapalaratnam R, Issar T, Poynten AM, et al. Diagnostic accuracy of nerve ultrasonography for the detection of peripheral neuropathy in type 2 diabetes. Eur J Neurol. 2022;29(12):3571-3579.
27. Dellon AL. A cause for optimism in diabetic neuropathy. Ann Plast Surg. 1988;20(2):103-5.
28. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2(7825):359–362.
29. Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992;89(4):689-97.
30. Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004;53(6):517-22.
31. Sayed D, Deer T R, Hagedorn JM., et al. A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET. J Pain Res 2024;17, 1461–1501.
32. Qureshi Z, Ali MN, Khalid M. An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy. J Diabetes Res. 2022;9989272.
33. Hernando-Garijo I, Medrano-de-la-Fuente R, Mingo-Gomez MT, et al. Effects of exercise therapy on diabetic neuropathy: A systematic review and meta-analysis. Physiother Theory Pract 2024;40(9):2116-2129.
34. Yang K, Wang Y, Li Y, et al. Progress in the treatment of diabetic peripheral neuropathy. Biomed Pharm 2022; 148:112717.
35. Zimmerman M, Dahlin E, Thomsen NOB, et al. Outcome after carpal tunnel release: impact of factors related to metabolic syndrome. J Plast Surg Hand Surg. 2017;51(3):165-171.
36. Moradi A, Sadr A, Ebrahimzadeh MH, Hassankhani GG, Mehrad-Majd H. Does diabetes mellitus change the carpal tunnel release outcomes? Evidence from a systematic review and meta-analysis. J Hand Ther. 2020;33(3):394-401.
37. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve 2011;44:597–607
38. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-9.
39. Billig JI, Kotsis SV, Ouyang Z, Wang L, Chung KC. A Quality Collaborative Study of the Concordance of Electrodiagnostic Scores and Clinical Severity in Carpal Tunnel Syndrome. Plast Reconstr Surg. 2022;150(6):1287-1296.
40. Shapiro LM, Kamal RN. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome. J Am Acad Orthop Surg. 2025;33(7):e356-e366.
41. Graham B., Regehr G., Naglie G., Wright J.G.: Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am 2006 Jul-Aug; 31: pp. 919-924.
42. Grandizio LC, Ozdag Y, Mettler AW, et al. Sensitivity, Specificity, and Reliability of the CTS-6 for Carpal Tunnel Syndrome Administered by Medical Assistants. J Hand Surg Am. 2024;49(7):656-662.
43. Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27(7):1783-8.
44. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-62.
45. Rota E, Morelli N. Entrapment neuropathies in diabetes mellitus. World J Diabetes. 2016;7(17):342-353.
46. Tannemaat MR, Datema M, van Dijk JG, Midha R, Malessy MJ. Decompressive Surgery for Diabetic Neuropathy: Waiting for Incontrovertible Proof. Neurosurgery. 2016;79(6):783-785.
47. Diabetes Canada Clinical Practice Guidelines Expert Committee, Bril V, Breiner A, Perkins BA, Zochodne D (2018) Neuropathy. Can J Diabetes 42 Suppl 1: S217–S221
48. Atmaca A, Ketenci A, Sahin I, et al. Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach. Front Endocrinol (Lausanne). 2024;15:1380929.
49. Gad H, Kalra S, Pinzon R, et al. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst. 2024;29(1):28-37.
50. Rozen SM, Wolfe GI, Vernino S, et al. Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial. Ann Surg. 2024;280(1):35-45.
51. Beard DJ, Campbell MK, Blazeby JM, et al. Considerations and methods for placebo controls in surgical trials (ASPIRE guidelines). Lancet. 2020;395(10226):828-838.
52. Best TJ, Best CA, Best AA, Fera LA. Surgical peripheral nerve decompression for the treatment of painful diabetic neuropathy of the foot - A level 1 pragmatic randomized controlled trial. Diabetes Res Clin Pract. 2019;147:149-156.
53. van Maurik JFMM, van Hal M, van Eijk RPA, Kon M, Peters EJG. Value of surgical decompression of compressed nerves in the lower extremity in patients with painful diabetic neuropathy: a randomized controlled trial. Plast Reconstr Surg. 2014;134(2):325-332.
54. Rinkel WD, de Kleijn JL, Macaré van Maurik JFM, Coert JH. Optimization of Surgical Outcome in Lower Extremity Nerve Decompression Surgery. Plast Reconstr Surg. 2018;141(2):482-496.
55. Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992;89(4):689-9
56. Aszmann OC, Kress KM, Dellon AL. Results of decompression of peripheral nerves in diabetics: a prospective, blinded study. Plast Reconstr Surg. 2000;106(4):816-22.
57. Wieman TJ, Patel VG. Treatment of hyperesthetic neuropathic pain in diabetics. Decompression of the tarsal tunnel. Ann Surg. 1995;221(6):660-4; discussion 664-5.
58. Aszmann O, Tassler PL, Dellon AL. Changing the natural history of diabetic neuropathy: incidence of ulcer/amputation in the contralateral limb of patients with a unilateral nerve decompression procedure. Ann Plast Surg. 2004;53(6):517-22.
59. Fadel ZT, Imran WM, Azhar T. Lower Extremity Nerve Decompression for Diabetic Peripheral Neuropathy: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2022;10(8):e4478.
60. Louca M, Meares C, Dusseldorp JR. Decompressive Nerve Surgery Associated with Low Diabetic Foot Ulcer Rate and High-Risk Bias: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2025;155(4):809e-820e.