Neuropathy – Anderson Podiatry Center

Diabetic Nerve Pain in Feet: New Hope Through Advanced Treatments

Posted on June 16, 2025June 27, 2025 by admin

Living with diabetes brings many challenges, and diabetic nerve pain in feet ranks among the most debilitating complications. This condition, called diabetic neuropathy, affects millions of people with diabetes worldwide. The good news is that recent advances in treatment offer new hope for managing this painful condition.

Understanding Diabetic Neuropathy

Diabetic neuropathy occurs when high blood sugar levels damage nerves throughout your body over the long term. The most common type is diabetic peripheral neuropathy, which primarily affects nerves in your feet and legs. This nerve damage can severely impact your ability to feel pain, temperature, and touch.

The condition affects nerves that control various body functions. When blood vessels that supply these nerves become damaged, it leads to the characteristic symptoms many patients experience. Managing your blood sugar levels is crucial, as elevated glucose damages both blood vessels and nerve fibers over time.

Types of Diabetic Neuropathy

There are several types of diabetic neuropathy, and symptoms depend on the type affecting you:

Peripheral Neuropathy: The most common type, causing numbness, burning sensations, and sharp pains in feet and legs. Many patients report symptoms become worse at night.

Autonomic Neuropathy: This type affects nerves that control internal organs, including blood pressure heart regulation, digestive system, and sex organs. It can impact bladder control and sexual function.

Proximal Neuropathy: Affects nerves in the hips, thighs, and buttocks, causing sudden weakness and pain.

Focal Neuropathy: Targets specific nerves, creating localized weakness or pain in particular areas.

Understanding which type affects you helps doctors create the most effective treatment plan for your specific situation.

Why Feet Are Most Vulnerable

Your feet bear the brunt of diabetic neuropathy for several reasons. The longest nerves in your body extend to your feet, making them most susceptible to damage from high blood sugar. Additionally, blood vessels supplying these distant nerves often sustain damage first, reducing oxygen and nutrient delivery to nerve tissues.

This nerve damage impairs your ability to feel pain properly, which normally serves as a protective warning system. Without this protection, minor injuries can go unnoticed and develop into serious complications.

Breakthrough Research: Dr. James Anderson’s Nerve Decompression

Recent groundbreaking research by Dr. James Anderson, DPM, has revolutionized treatment approaches for diabetic nerve pain in feet. His work focuses on nerve entrapment, where damaged nerves become compressed in anatomical tunnels throughout the lower legs and feet.

Dr. Anderson’s research demonstrates that nerve decompression surgery can significantly improve symptoms by relieving pressure on compromised nerves. This surgical technique targets specific compression points, improving blood flow and reducing nerve irritation.

Benefits of Nerve Decompression Surgery

Patients who undergo Dr. Anderson’s nerve decompression procedures often experience:

Restored sensation in feet and toes
Significant reduction in burning and stabbing pains
Lower risk of foot ulcers and potential amputations
Improved balance and walking stability
Potential restoration of some lost nerve function

Early intervention produces the best outcomes, emphasizing the importance of seeking treatment before irreversible damage occurs.

Essential Foot Care for People with Diabetic Nerve Pain In Feet

Proper foot care remains fundamental for anyone managing diabetic peripheral neuropathy. Daily inspection helps identify problems early, before they become serious complications.

Daily Foot Care Routine:

Examine feet thoroughly for cuts, blisters, or color changes
Keep feet clean and completely dry
Wear properly fitted, supportive footwear
Never walk barefoot, even indoors
Moisturize feet but avoid areas between toes

These simple steps can prevent minor issues from becoming major complications that threaten your mobility and independence.

Comprehensive Treatment Approaches For Diabetic Nerve Pain In Your Feet

Managing diabetic nerve pain in feet requires a multi-faceted approach combining various treatment options:

Blood Sugar Management: Maintaining stable blood sugar levels remains the cornerstone of preventing further nerve damage. Work closely with your healthcare team to optimize your diabetes management plan.

Medication Options: Several medications can help manage neuropathy pain, including specific pain relievers, certain antidepressants, and anti-seizure medications that affect nerve pain signals.

Physical Therapy: Targeted exercises improve strength, balance, and mobility while helping maintain nerve function in affected areas.

Topical Treatments: Creams containing capsaicin or lidocaine patches can provide localized pain relief for some patients.

Nutritional Support: Certain vitamins and supplements may support nerve health, though you should discuss these options with your physician before starting any new supplements.

Managing Related Health Concerns

Diabetic neuropathy often affects more than just your feet. Autonomic neuropathy can impact blood pressure heart function, digestive processes, and sex organs. Working with your healthcare team to address these interconnected issues improves your overall quality of life.

Regular monitoring of blood pressure, heart health, and other organ functions helps detect and treat complications early. This comprehensive approach ensures you receive the most effective care for all aspects of your condition.

Hope for the Future

Thanks to pioneering research from specialists like Dr. James Anderson, treatment options for diabetic nerve pain in feet continue expanding. Nerve decompression surgery represents just one exciting advancement offering hope for symptom improvement and potential nerve function restoration.

The key to success lies in early intervention and comprehensive care. If you experience symptoms of diabetic neuropathy, don’t wait for them to worsen. Speak with your healthcare provider about all available treatment options, including advanced surgical techniques that might be appropriate for your situation.

With proper foot care, diligent blood sugar management, and access to cutting-edge treatments, living well with diabetic neuropathy is increasingly possible. Take control of your condition today by exploring all available options and working with specialists who understand the latest advances in neuropathy care. View more informational and testimonial videos on our YouTube Channel.

Watch Our Informational Videos On Nerve Pain From Diabetic Neuropathy

Schedule Your Appointment To Treat Diabetic Nerve Pain In Feet

Call us today at our Fort Collins location (970) 484-4620, Broomfield location (720) 259-5053 or use our online scheduling system to book your appointment.

Restless Legs Syndrome Causes and Effective Treatment

Posted on March 28, 2025June 27, 2025 by admin

What Is Restless Leg Syndrome?

Restless legs is thought to affect approximately 10% of the population. Perhaps half of those people may be having mild symptoms, but the other half may be having severe symptoms. Sadly, restless legs is a problem that primary presents itself at night as many people can function fine during the day. Once one goes to bed, the symptoms may start. While the rest of us are sound asleep, their sleep is interrupted and for many, the amount of sleep they get is severely limited. Another name for restless legs is Willis Ekbom disease.

Restless Legs Causes and Symptoms

Restless leg syndrome sensations

Most will agree that one of the most common symptoms of restless leg syndrome, RLS, is anxiousness. Some will call it nervous legs. Once a patient with restless legs goes to bed or sits down, their feet and legs may start to feel anxious and have the irresistible urge to move your legs to alleviate the symptoms. In bed at night, many patients have to get up and walk around multiple times. Other symptoms may include twitching that can happen involuntarily, and others may have creepy crawly sensations and cramping. When the jerking is severe, it is referred to as “periodic limb movement disorder” or also called periodic limb movement of sleep.

What are Thought to be The Causes Of Restless Legs

Drugs to treat restless legs:

Conventional medicine has some studies that would point to a lack of dopamine in the brain as being a risk factor for restless legs. Dopamine is a neurotransmitter and because of these studies, conventional medicine suggests increasing dopamine levels may provide relief. Therefore, medications that increase dopamine levels are prescribed. The medicines that increase dopamine levels are ropinirole and Mirapex. Taking these medications may have significant side effects for patients and once you start taking these medications, and with worsening symptoms, the doses might be increased, and you may go through a process called augmentation.

Augmentation happens when you reach a maximum dose as the symptoms of restless legs continue to worsen. There can also be severe withdrawal symptoms from these medications. These medications have also been shown to cause addictive disorders such as addiction to vices such as gambling and sex . Other medications that are recommended include gabapentin and Lyrica. These drugs are frequently recommended in the treatment of neuropathy. Some of their side effects include fogginess and weight gain from taking Lyrica . Low iron levels or iron deficiency may impact restless legs and there are some patients who are suggested to take iron supplements as treatments to increase iron levels. However, some doctors who specialize in sleep medicine may suggest doing sleep studies where patients are observed in a lab to see how much of their sleep is disrupted.

Restless Legs Syndrome Treatment

Non-drug treatments:

Other than the use of pharmaceuticals, the following may be helpful especially when the symptoms are mild:

Massage the legs before bed
Take a warm bath or use heating pads
Exercise regularly
Avoid caffeine, alcohol, and nicotine

How is Restless Legs Diagnosed?

Restless legs is unusual that the diagnosis is made by the patient’s symptoms. There are no definitive tests that are used to diagnose restless legs.

Refractory Restless Legs Syndrome

For many, medications may be helpful but there are patients that have refractory RLS which means they do not respond to any medications that they are given.

Risk factors:

Diabetes – this medical condition can increase the likelihood of having restless legs symptoms.
Genetics – many studies claim that many people with restless legs have somebody else in the family who also has restless legs.
Gender – restless legs occur twice as frequently in women than men
Other health conditions – kidney disease, iron deficiency, and pregnancy may also be associated with restless legs.

Why You Should Challenge Conventional Medicine’s Claim That There is No Known Cause or Treatment That Can Reverse Restless Legs?

For over a decade, we have had success reversing restless legs by opening the nerve pathways in the lower extremity where nerve tunnels have become tight and are compressing on nerves. Today we have one peer-reviewed study to validate our outcomes, and another study has been submitted for publication.

If The Symptoms are in Your Legs, Why Can’t The Cause be in Your Legs?

Understand that conventional medicine has no interest in embracing the concept of evaluating the peripheral nervous system and finding the cause of restless legs there. They continue to promote drugs by selling Ropinirole, Mirapex, and other medications to the public through the doctors and medical research institutions that have been monetized to research more drug options. In recent years, the public has become more concerned about Big Pharma, and this is another area that you should have concerns about regarding restless legs. Consider this: if you are reading this blog and you see your doctor for restless legs, did you have a full neurological hands-on clinical examination of your legs? The answer is no. This in itself is evidence that doctors are not trained to consider the peripheral nervous system as a cause of your restless legs. The doctor will listen to your history, and based on your symptoms will give you the diagnosis of restless legs. They have not collaborated with your subjective complaints to a thorough examination of the health of the nerves in your legs.

The Story Behind The Discovery That Restless Legs is Reversible

My original training was with a professor of neurosurgery and plastic surgery at Johns Hopkins. His expertise was in upper extremities such as carpal tunnel surgeries. He took the principles of these concepts and applied them to the lower extremities, and I was one of the earliest doctors to start opening tight nerve tunnels in the lower extremities similar to carpal tunnel surgery, and have been able to reverse patient symptoms of patients suffering from neuropathy over 20 years. Over a decade ago, additional nerve tunnels in the legs were discovered and the tunnels were examined and were shown to be tight. We noted that by opening the tunnels we were having success not only reversing neuropathy but also restless leg symptoms. Gradually over time, we were showing that patients who have primarily restless leg symptoms with little neuropathy symptoms benefit from these restless legs syndrome treatment surgeries.

We perform restless legs syndrome treatment surgeries on a weekly basis, and many patients travel from throughout the United States and other countries to have a full neurologic evaluation and have the surgeries performed. I have also published a bestseller Amazon book called A Perfect Night’s Sleep. This book will give you more information regarding the pathway that led me to this discovery and also multiple patient stories along with research data to back up the success of these surgeries. Finally, we have one peer-reviewed, published study showing improvement of symptoms after nerve decompression surgery. Another study has been submitted for publication that measures nerve function before and after the nerve tunnels are open and demonstrates nerve function improvement. This proves objectively that nerve function is improved and correlates to the patient’s reversal of symptoms. You may also find other studies that have been published on our website and I have had the honor of receiving the Jules-Tinel Award for this body of research from my peers.

When to See A Doctor About Restless Legs Syndrome Treatment

When symptoms are mild, non-drug treatments may have some effects, however, when you start losing significant amount of sleep it may be time to consider consulting and doing conventional treatments with medications or consider the more modern approach to addressing the cause of the problem with nerve decompression surgery.

Serious RLS Should Not be Taken Lightly

The importance of a good night’s sleep to your physical and also mental health has become more apparent in research recently. There are studies that back up how a lack of sleep has a severe on men and women and can increase risk of early death. One study of 18,425 men found that men with RLS had 39% increased risk of death compared to men without RLS (source), and then for women it found that it was a 43% increased risk of dying from heart attack (source). Another study also found that RLS was associated with higher risk of suicide or self-harm (source).

Conclusion

More patients are seeking non-drug options for many healthcare treatments including RLS. For those of you who want to avoid medications or are already on medications and are suffering from the bad side effects or diminishing returns, please consider the option we recommend for restless leg syndrome treatment. We have many patients who enjoy getting back to being the person they used to be, having more energy, and appreciating the physical and mental well-being of having a full night’s sleep.

Frequently Asked Questions (FAQs) About Restless Legs Syndrome Treatment

More evidence to back up that compression of nerve tunnels causes restless legs syndrome:

Q: Muscle weakness – Why do we frequently observe muscle weakness in the muscles of the foot and/or leg with patients with RLS?
A: damaged nerves are causing this weakness.

Q: Lack of sensation – Why can we demonstrate through our clinical assessment that people have less than optimal sensation in their feet?
A: damaged nerves are causing a reduction or abnormal sensation on the feet.

Q: Ultrasound evaluation – why can we often see with diagnostic ultrasound that the nerves that cause RLS are being compressed?
A: in the majority of cases, we observe compression on the nerve at the tunnels that are decompressed.

Q: Intraoperative nerve monitoring with EMG – Why is it that we have objective evidence during surgery that the nerves are working better after the nerve tunnels have been opened than before?
A: This supports that the nerve tunnels in the legs are too tight and are damaging the nerves.
Q: Recovery rate – How soon the patients experience relief?
A: This can happen within days. Follow the link to see an example as the operated leg from a week earlier is not jerking while the leg to be operated on is jerking immediately before surgery is performed.

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Why You’re Not Hearing How Diabetic Neuropathy Can Be Reversed!

Posted on August 16, 2024June 27, 2025 by admin

For many suffering from diabetic peripheral neuropathy, the information in this blog may be the most important you need to know when seeking treatment. We will discuss the basics of diabetic neuropathy and the conventional treatment options. However, you’ll learn how it’s reversible and we will contrast how centralized medicine continues with the same old dogma that you cannot reverse it. So, consider the other option I’ll be explaining. I will explain why I consider myself and my colleagues decentralized doctors, so you’ll better understand why centralized medicine keeps this information from you. You’ll also get access to research to prove my claim.

Approximately 50-70 percent of those suffering from diabetes will develop neuropathy. The symptoms of diabetic neuropathy will be burning, tingling numbness, and sometimes weakness in the feet and may extend above the ankles into the lower legs. The challenge is that as you lose sensation it will put you at greater risk of an amputation, the most concerning complication of diabetes.

With the nerves that control sensation your ability to feel a sore, like a callous, will be diminished. That callous may become deep, breaking down the skin and resulting in an ulcer. Then an infection may start with infection getting into bone and an amputation of a toe or portion of the foot may be necessary. Because of this risk people with diabetes are more at risk of early death from this amputation risk. The autonomic nervous system may also be damaged with diabetes. This may affect the heart, bladder, sweat glands, and sexual function.

Types of diabetic neuropathy

Small fiber disease– This is a common type of neuropathy and this term is used to describe nerve damage to the small nerve fibers that lie right beneath the skin. By taking a biopsy of the skin, the number of nerve endings can be counted to see how many are dying. Small fiber disease will cause burning tingling and numbness as the nerve endings die.
Large fiber disease – This may also occur but is not frequently talked about. This is nerve damage from compression. The compression is coming from nerve tunnels that become too tight. Carpel tunnel syndrome would be an example of this.
Type one and type two diabetes – You’ll commonly hear these terms and it’s important to know what they mean. Type 2 diabetes is most common and affects people later in life. The pancreas still makes insulin but in smaller amounts. Type 1 diabetes refers to diabetes that starts at a young age and the pancreas does not produce insulin.

Conventional treatments for diabetic neuropathy

Treatments are the following

Control diabetes – It is thought that controlling your blood sugar levels will be less damaging to the nerves and therefore the progression of neuropathy may be reduced. By controlling risk factors such as too much sugar and carbohydrate intake glucose levels can be better controlled.
Medications– medications such as Lyrica and Gabapentin are commonly recommended to control the symptoms as they become more severe. These drugs may have a positive effect on the burning tingling and numbness symptoms. In rare instances, narcotics may also be prescribed.
Medications for controlling blood sugar levels – These can vary depending on the type of diabetes you have and by controlling sugar levels less damage to the nerves may take place.
Exercise – this may improve blood flow. Also, it may help the body’s metabolism to control high blood sugars and have a positive effect on the health of the nerves. The blood vessels that supply the nerves may be better able to keep the nerves healthy. It will also reduce risk factors such as weight and high blood pressure.

Here’s what you’re being told about your diabetic neuropathy.

It’s not reversible and if you have it it’s from metabolic issues. The high glucose levels are detrimental to the nerves so the primary solution is medication to help with the symptoms. This is the centralized medical recommendation. Most of healthcare has bought into this narrative. It begins in medical schools with training of doctors to prescribe these drugs and also with the millions of dollars spent by big pharma to promote to the public. Understand the centralized concept is that big pharma along with government agencies fund the research that we fund through our taxes and then promote to you and doctors. No wonder that’s all you’re hearing.

The other new option for diabetics with neuropathy

Surgical reversal of your diabetic neuropathy. Yes, surgery can reverse your diabetic neuropathy.

The basics of nerve decompression for diabetic neuropathy.

When your blood sugars are higher than normal, glucose is broken down by another metabolic pathway called the polyol pathway. In this process, a sugar molecule called sorbitol is created. The sorbitol molecule then gets into the peripheral nerves and attracts water to the nerves. As more water is absorbed into the nerve it will swell as much as forty percent. The swelling of the nerve then creates compression on the nerve as it travels through nerve tunnels. This is why carpal tunnel syndrome is much more common in diabetics. This argument has been around for over twenty years. This information is coming from decentralized doctors like me. No drug company has funded my research, it is there to be read by all doctors and the public.

Objective research to prove that diabetic neuropathy is reversible. Me and my team of doctors have published two papers providing objective evidence of diabetic neuropathy. Two attempts were made to present this at the national meeting of the American diabetic association, and we were turned down. I was innocent enough to think we would be accepted with open arms. Obviously, there is another agenda.

The basics of our research. Patients with severe diabetic neuropathy underwent nerve decompression surgery to remove pressure on the nerves in the lower extremity. Intraoperative EMG studies were done before and then immediately after the nerve tunnel had been opened and decompressed. To do the test needle electrodes were placed in the muscle that the nerve supplied to measure how much the nerve caused the muscle to contract before and after the nerve tunnel was opened. Some patients had up to 300 percent change in this number. Again, this is objected data supplied by a machine used to measure nerve function. So, it is indisputable evidence and helps with understanding the relation to finding the right treatment for diabetic neuropathy. Here are the two studies.

Acute Improvement in Intraoperative EMG Following Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: 1. EMG Results

Acute Improvement in Intraoperative EMG During Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: EMG and Clinical Attribute interrelations

Since those two studies were done there is even more research to show that patients undergoing these procedures for treatment of their diabetic neuropathy have significantly reduced the potential for an ampuation. A study by Dr. Zhang in china reports emg nerve testing before and after surgery. ¹

Dr. Zhang and Dr. Anderson - Nerve Monitoring for the treatment of Diabetic Neuropathy — Dr. Zhang and Dr. Anderson – Nerve Monitoring for the treatment of Diabetic Neuropathy

Amputation costs to the healthcare system can be a minimum of 80,000 dollars. Besides the monetary price, there is the cost of human life as once a limb is amputated life span is significantly reduced.

So if the centralized medical dogma could be shifted fewer drugs would be sold, fewer patients would need to go to wound care centers where many centralized medical products are used. You’re not hearing the option because if you’re a diabetic patient that is conscientious about your diabetic condition you are consulting with your doctors who manage your condition. Yet they are slow to change and have continued with the medical dogma of centralized medicine. As a peripheral nerve surgeon myself and my colleagues have patients coming to us that refuse to accept the status quo. Sadly, for new concepts to get traction and be fully accepted by the masses it takes a lot of capital.

Doctors have to be monetized so that the services we offer have a positive effect on a company or industry that collaborates with us to move the new concept forward. They win, the doctors win and so do the patients. So this relationship does not exist for doctors that do what me and my colleagues do for the treatment for diabetic neuropathy. As of yet there is no such relationship with an industry with big pockets to promote and further research what we do. Yes, for many the drugs that are used are helpful at reducing the symptoms. However they also allow for the deterioration of the nerves to continue and the risk of amputations go up! If you’d like to learn more about someone in your area who is trained as a peripheral nerve surgeon, please go the Association of Extremity Nerve surgeons website.

Call us today at our Fort Collins location (970) 484-4620, Broomfield location (720) 259-5053 or use our online scheduling system to book your appointment.

References

¹ Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy
Zhang W, Zhong W, Yang M, Shi J, Guowei L, Ma Q. Evaluation of the clinical efficacy of multiple lower-extremity nerve decompression in diabetic peripheral neuropathy. Br J Neurosurg. 2013 Dec;27(6):795-9. doi: 10.3109/02688697.2013.798854. Epub 2013 May 29. PMID: 23713665.
https://pubmed.ncbi.nlm.nih.gov/23713665/

Is Sciatica Pain In Your Foot From Your Back? Wrong, Here’s Another Cause

Posted on July 22, 2024June 27, 2025 by admin

Many have heard of sciatic foot pain a term that refers to pain caused by the sciatic nerve. It’s been assumed that if you have nerve pain that radiates down your upper leg down into your lower leg and into the foot it’s likely sciatic pain. These sciatic symptoms will consist of nerve pain such as burning, tingling, and numbness that extends down to the foot causing foot pain. In many situations this may be, however, the purpose of this blog is to challenge this long-standing assumption. Yes, there may be another cause so treatment of your back with the eventual possibility of back surgery needs to be reevaluated as it may not always be the primary cause. Before we dive into this let’s make sure you have some basic understanding of sciatic foot pain.

Sciatic Foot Pain – The Conventional Approach

The sciatic nerve is the primary nerve that originates from the lower back. The origin is from nerve branches that originate from lumbar 1 and 2 and also sacrum 1,2,3. These branches form the sciatic nerve. There may be a herniated disk at one or more of these levels that creates sciatic pain from the nerve damage. Others may also have spinal stenosis at one of these levels or bone spurs causing pressure on the nerves.

Therefore conventionally the primary cause has always been that sciatic pain comes from pressure on the sciatic nerve as it originates from these branches. Following the nerve down into the leg it then travels down the buttock area into the back of the upper leg in the hamstring area. Just above the knee, it splits into two branches one is called the tibial nerve which travels down the back of the lower leg and eventually supplies all the nerves for the bottom of the foot. The other nerve called the common peroneal nerve travels to the outside of the knee just below the knee joint. It eventually supplies the majority of the top of the foot.

As we already mentioned this is the primary nerve that supplies nerves to the top of the foot. It’s important to note that right after it splits off from the sciatic nerve just above the knee joint and travels around the outside of the knee it goes through a nerve tunnel. This nerve tunnel is referred to as the common peroneal nerve tunnel. It’s very similar to the ulnar nerve tunnel of the elbow which patients may be more familiar with. For over two decades, I have been doing decompression surgeries on this nerve tunnel to open it and relieve pressure on the common peroneal nerve.

The common peroneal nerve can be implicated nerve conditions such as neuropathy, restless legs syndrome, and drop foot. I have been able to reverse each of these conditions by doing surgery on this nerve tunnel. Read my paper on Common Peroneal Nerve. We have also discovered that some of these patients suffering from neuropathy, restless legs, or drop foot may also be experiencing sciatica foot pain. They report nerve symptoms in the buttock area going down into the upper leg that disappear when we decompress the common peroneal nerve.

Double Crush Syndrome

A simple definition of double crush syndrome is when a peripheral nerve has one area of compression on the nerve, but another area of compression may also exist. Therefore we call it double crush . The interesting thing about this concept is that these two areas of compression affect each other. In other words, using sciatica as an example a bulging disc or bone spur may be creating compression on the peripheral nerves as they exit the spinal cord in the back and further down the leg at the location of the common peroneal nerve tunnel there is also compression sciatic pain can be reversed without back surgery. Why? By eliminating pressure on the common peroneal nerve at its tight nerve tunnel compression will still exist in the back but the sciatic nerve will be less sensitive to the compression and sciatic nerve pain will be reversed.

That is why in my many years of doing surgery on the common peroneal nerve we have noted that patients may have pain relief above the knee along the sciatic nerve into the back and also below the knee into the foot. Again there is still compression in the back that may be observed with an MRI however the nerve at the location is less sensitive and therefore the sciatic symptoms are not only relieved above the knee going into the back but also from the knee going down into the foot.

What is the significance of Double Crush and Common Peroneal Nerve Entrapment?

Avoiding back surgery – It could be that back surgery could be avoided as the common peroneal nerve is playing a larger role that was ever understood. Decompression of the common peroneal nerve would be less risky.
Failed back surgery – When back surgery has failed to eliminate sciatic pain or back pain decompression of the common peroneal nerve may be involved and offer another option rather than a repeated back surgery attempt.

How do we know if the Common Peroneal Nerve is an Issue?

Clinical examination – Patients may have slight muscle weakness, drop foot, and loss of sensation along the distribution of the common peroneal nerve. Symptoms may be present on the top of the foot and the front of the leg.
Diagnostic ultrasound – Imaging by using ultrasound may show compression at the nerve tunnel.

Emg and nerve conduction studies – These studies can sometimes show the involvement of the common peroneal nerve but are not always highly accurate.
Diagnostic injections – a new technique called the Phoenix test can be used. This involves using a small amount of local anesthesia and placing it under the skin but above the common peroneal nerve. Ultrasound guidance is used for precise placement of the anesthesia. Within minutes patients will usually respond resulting in dramatic symptom relief which will help support that the common peroneal nerve tunnel may be the root cause of the symptoms.

So if you’re trying to get relief from your sciatic foot pain that is extending into your foot it is important the consider the possibility of the common peroneal nerve being an issue. Please understand that unless you are seen by a peripheral nerve surgeon this possibly may not be a consideration.

Schedule your appointment online or call our Fort Collins and Broomfield, Colorado locations to connect with a trusted foot doctor near you at our renowned foot and ankle clinic.

Call us today at our Fort Collins location (970) 484-4620, Broomfield location (720) 259-5053 or use our online scheduling system to book your appointment.

References

Maejima R, Aoyama M, Hara M, Miyachi S. Double Crush Syndrome of the Lower Limb in L5 Radiculopathy and Peroneal Neuropathy: A Case Report. NMC Case Rep J. 2021 Dec 22;8(1):851-855. doi: 10.2176/nmccrj.cr.2021-0169. PMID: 35079559; PMCID: PMC8769459.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769459/

Deciphering Posterior Tibial Nerve Issues: Unraveling the Mystery of Foot Nerve Pain

Posted on December 6, 2023 by admin

Understanding the Role of the Posterior Tibial Nerve

Have you considered the posterior tibial nerve as the potential culprit behind the nerve pain in your foot? This blog delves into the functions of the posterior tibial nerve, exploring its impact on the bottom of your foot and the diverse symptoms it may trigger, including burning, tingling, numbness, and weakness.

Unveiling the Anatomy: The Tarsal Tunnel Connection

Before we explore the anatomy of the foot, let’s pinpoint the location of the posterior tibial nerve. This nerve traverses a crucial passage known as the tarsal tunnel, situated on the inside of your ankle. Similar to the carpal tunnel in your wrist, a tight tarsal tunnel can elicit symptoms mirroring carpal tunnel issues. The resulting burning, tingling, and numbness might necessitate tarsal tunnel surgery, paralleling the approach taken for carpal tunnel syndrome in the hand. Let’s embark on an anatomy lesson to deepen our understanding of the nerves supplying the bottom of your foot.

Three Potential Areas of Nerve Compression

Before jumping into the intricacies, dispel the notion that nerve symptoms on the bottom of the foot solely originate from the back. We’ll explore three potential areas, starting above the knee.

Above the Knee: Nerve Branches and the Sciatic Nerve
Beginning in the lower back, nerve branches extend from the lumbosacral area to form the sciatic nerve. This nerve travels deep into the buttock muscles, also known as the gluteus muscles.

First Potential Site: Piriformis Syndrome
In this region, the piriformis muscle, a small but impactful muscle, can tighten and compress the sciatic nerve. While this is the first potential site for nerve compression, it is the least common and least likely to necessitate surgical intervention.

Second Potential Site: The Soleal Sling
The tibial nerve continues its journey towards the back of the knee, passing through the popliteal fossa. Here, the soleal sling, a fibrous band of tissue, may cause compression. This area is critical for supporting various foot muscles and can contribute to nerve pain.

The Journey of the Posterior Tibial Nerve

The tibial nerve, continuing down the leg, divides into multiple branches, eventually becoming the posterior tibial nerve. As it approaches the inside of the ankle, it undergoes a name change, becoming the tibialis posterior nerve.

Third Potential Site: Tarsal Tunnel Syndrome
Approaching the inside of the ankle, beneath the laciniate ligament or flexor retinaculum, the nerve transforms into the posterior tibial nerve. Here, it divides into three main branches supplying the sole of the foot. Let’s unravel this intricate network, detailing the nerves and muscles involved.

Examining the Nerves in Detail

Medial Calcaneal Nerve: Supplies the bottom of the heel.
Medial Plantar Nerve: Provides sensation to the skin on the bottom of the first, second, and half of the third toes. Also, supports intrinsic foot muscles.
Lateral Plantar Nerve: Supplies the skin on the lateral half of the foot and various muscles, assisting in foot movement.

The Author’s Perspective

From the viewpoint of the author, a board-certified peripheral nerve surgeon recognized with the Jules Tinel award, three potential locations for nerve compression—piriformis muscle, soleal sling, and tarsal tunnel—must be considered when experiencing bottom-of-the-foot nerve symptoms.

Challenging Conventional Medicine

Challenging the conventional approach, the author contests the idea that back-related issues are the primary cause of foot nerve symptoms. Additionally, the blog questions the common narrative of neuropathy and suggests alternative approaches.

Our Approach to the Problem

The author advocates for an in-depth evaluation, emphasizing muscle strength testing and diagnostic ultrasound to identify nerve compression. Sensation testing and a holistic approach, considering supplements and lifestyle changes, are also highlighted.

Treatment Options

The blog outlines conservative treatments such as lifestyle changes, supplements, and ETIM and Laser treatments. For those requiring surgical intervention, procedures like piriformis surgery, soleal sling surgery, and tarsal tunnel surgery are discussed. Notably, the importance of recognizing the potential role of the soleal sling, often overlooked, in tarsal tunnel symptoms is emphasized.

Whether considering conservative or surgical options, the author encourages readers to seek a comprehensive evaluation and challenge conventional perspectives on foot nerve pain.

Nerve Damage From COVID Vaccine – Could This Be Causing Your Neuropathy?

Posted on April 12, 2023June 28, 2025 by admin

We have been seeing more and more glimpses of normality now that the world is coming out of the COVID pandemic, but those of us in the healthcare community are seeing what is suspected to be adverse effects of the vaccine. Yes, there is controversy about the vaccine, and yes, many question the risk of the vaccine versus the benefits – especially in younger individuals. Unfortunately, there are multiple data points indicating early death due to heart issues for men in the 18 to 39 age range as an example ¹. This risk is far less in the senior population where risk of getting COVID was considered greater. However, this blog is primarily to share what I’ve seen in my practice when it comes to neuropathy and COVID. As a podiatrist who specializes in lower extremity peripheral nerve surgery, I feel it’s important to share my experience and what I’ve seen. It’s important for those who are now suffering from nerve problems potentially related to receiving the vaccine, to feel a sense of reassurance, as I’d like to provide some solutions for them. Before the mrna vaccines for Covid, it was known that various vaccines may cause Guillain Barre Syndrome – a condition that causes the immune system to attack the nerves in the legs and arms. The occurrence of this was rare. Also, it’s important to consider the potential risk when considering further booster vaccines for others who may have noticed some mild nerve symptoms. This could save some from further nerve damage by electing not to get a booster.

For some who are experiencing nerve symptoms, they may be told they have neuropathy, so let’s define what it is. Neuropathy is a medical term used to describe nerve damage that results in the patient having symptoms of burning, tingling, and numbness. It may also lead to weakness in some cases. This weakness may present as drop foot in the lower extremity. It’s important to understand that neuropathy does not indicate what the cause is from. It simply means your nerves are not functioning normally.

Conventional Medicines View: Conventional medicine has been telling doctors and the public that neuropathy in the lower extremity and feet are caused by damage to nerves from metabolic issues or from the back.
Metabolic Issues: This would mean anything that would have a negative effect on the nerves. Examples of this could be diabetes, as high sugar levels may damage the nerves. Alcoholism; again this has a negative effect on nerves and your general health. Some autoimmune diseases and chemotherapy treatments may also be a cause. Finally, if the patient is healthy and has none of the above, they are said to have idiopathic neuropathy, neuropathy of unknown cause.
Back Issues: many doctors will look at the back as a possible cause. A pinched nerve in the low back may be treated with surgery, cortisone injections, physical therapy or chiropractic care. There are also some reports of patients having transverse myelitis, an inflammatory condition in the spinal cord. This could also cause symptoms in the lower extremity.

What We as Peripheral Nerve Surgeons are Saying and WHY it’s Important if You Have Nerve Damage From a mRNA Vaccine.

What I routinely share with my patients is that those trained in peripheral nerve surgery are 30 years ahead of the curve in treating lower extremity nerve conditions. Why? Because we are simply looking at the lower extremity similar to what hand surgeons have been doing for decades. We evaluate and treat nerve tunnels that may become tight just like carpal tunnel syndrome – If so, we can surgically decompress, and open the nerve tunnel involved, and reverse the nerve symptoms. Most doctors are poorly trained in evaluation and treatment in this way.

Evidence That Nerve Damage From COVID Vaccine is Reversible.

Consider this: before Covid and the potential adverse effect of the vaccine, patients with other secondary conditions, metabolic (as was mentioned early), have gained relief by treating the nerve tunnels in their legs and feet that had become tight. This is the case with diabetics. The diabetic state causes nerves to swell as sugar molecules called Sorbitol get into the nerve and attract water to the nerve. The nerve then swells, and this leads to compression as the tunnel size does not expand where it passes through. This causes increased volume since there is no stretch. Patients with chemotherapy induced neuropathy have also had reversal of their neuropathy from decompression. The concept is that before chemotherapy patients may have had preexisting tight nerve tunnels. The chemotherapy damages the nerve tissue making the nerve more sensitive to any preexisting compression. So when pressure is released symptoms improve.

The same could be argued for those suffering from nerve damage from the Covid vaccine. Have I seen a lot of this in my practice? No, and many have mild symptoms, but the question is: Will they progress over time? The other consideration is that patients are reluctant to bring it up to their doctor. From my experience with these patients, doctors are reluctant to consider the vaccine as a possibility. This frustrates patients as the symptoms usually start soon after the vaccine or symptoms increase with each subsequent vaccine. One particular patient had severe symptoms after having two vaccines and a booster. She also had a drop foot causing weakness and an inability to move her foot upwards. Here is her testimonial video:

Don’t lose hope If you suspect you had neuropathy from the MRNA vaccine. We have had an overwhelming response to the YouTube video of Kim whos’ neuropathy and drop foot symptoms were reversed. So, if you’ve been told that nothing can be done, consider seeing a doctor who specializes in peripheral nerve surgery.

They will examine the nerves in the lower extremity and see if compression of nerve tunnels is present. This may allow for the option of surgical decompression surgery and reversal of the symptoms. If symptoms aren’t severe, other options such as laser treatments and estim may be considered. Most doctors will tell you it’s irreversible, and put you on medication to look to the back for treatment – instead, give us a call today!

References

¹ October 07, 2022. State Surgeon General Dr. Joseph A. Ladapo Issues New Mrna COVID-19 Vaccine Guidance. Florida Health. https://www.floridahealth.gov/newsroom/2022/10/20220512-guidance-mrna-covid19-vaccine.pr.html

Medicine Is Missing The Boat In Detecting Prediabetic Neuropathy. What Can You Do?

Posted on January 30, 2023June 28, 2025 by admin

Diabetes is becoming more common worldwide. It is known that the number of people with diabetes is soaring. Countries where diabetes used to be rare such as China are seeing a significant increase. Why is that? Many experts would agree it’s the increase in spread of the American diet worldwide which can cause obesity ,one of many risk factors. It is thought that 22 percent of patients with diabetes in the United States are undiagnosed.

What are the symptoms of prediabetic neuropathy?

Neuropathic pain can include burning, tingling and numbness and in more severe cases muscle weakness may also occur. These symptoms occur in the feet and are called peripheral neuropathy. When your glucose levels increase your nerve fibers are damaged. This can lead to Type II diabetes and nerve damage.

How do I know if I’m becoming a diabetic?

The two most common blood studies done are glucose fasting and Hemoglobin A1C. Glucose fasting is taken after you fast and most laboratories will consider anything over 100 abnormal. Hemoglobin A1c will let you know over a period of the last two to three months has your glucose levels have been in an abnormal range. Anything under 5.7 is considered normal with the borderline range going from 5.7-6.4 so anything over 6.4 will be considered diabetic.

Is there a better way to know if you are becoming diabetic?

Yes, there is and the answer lies in two additional tests called insulin fasting and glucose tolerance testing. They can be the leading indicators that you’re progressing towards being prediabetic and having neuropathy symptoms.

Fasting insulin– this test measures your insulin level which will be elevated if you’re prediabetic. This lab result should be low. Under 5 is ideal and when it starts to be elevated to 10 or higher it and indication your prediabetic. When you have high insulin levels its an indicator that you’re attempting to get glucose out to the blood and into the body’s tissues. This can be from a high intake of sugars and carbohydrates.

Glucose tolerance test– This is a test taken after you have fasted. You drink a solution of sugar and the sugar levels are measured one hour after the intake. If you are normal, the glucose levels will elevate but to a reasonable level. If you are prediabetic the sugar levels will be excessively elevated. It’s telling you that you have impaired glucose tolerance meaning you’re becoming insulin resistant. The pancreas is no longer able to create enough insulin and therefore the body’s tissues become unable to respond to the effect of insulin which is to deliver glucose from the bloodstream to the body’s tissues. Therefore, your blood sugars levels are elevated.

These two tests are used infrequently. From personal experience, I find many patients with the beginnings of neuropathy type symptoms will report to me that they have had borderline Hemoglobin A1c for 2,3 or 4 years. This is a frequent occurrence for those of us trained in peripheral nerve surgery. Once Hemoglobin A1c levels get into the abnormal range patients are placed on medication. It’s my opinion this is by design. It’s this doctors concern that Big Pharma has managed to educate doctors that this is how the rules are played. Unfortunately, what some podiatrists see are patients who are developing neuropathy and never had their insulin levels or glucose tolerance tests done. Sadly these test results may have indicated that they are heading towards a diabetic state.

Armed with this information, the patient would have the option to exercise more or modify their diet to either delay or avoid the diabetic state.

What complications can arise from prediabetic neuropathy in the foot?

Complications can include suffering from the symptoms of neuropathy which can interfere with your activities and sometimes makes sleeping difficult. But most importantly complications can include amputations.

Three things you can do to reverse this issue.

Exercise – This does not have to be complicated, just find something you enjoy doing and be consistent with it . Walking 20-30 minutes three times a week alone can help. Lifting weights , swimming, or pickleball.
Modify your diet – avoid as many processed foods as possible. Some of these may be loaded with different types of sugar that you may not be aware of. Many have high levels of fructose corn syrup which may be the worst form of sugar; many juices also contain this.
Reduce your intake of sugar and carbohydrates.
1. Consider eating more fats – Healthy fats in meat and even bacon if it is grass fed are helpful as these fats satiate your appetite and you’ll eat less. Use more grass-fed butter and consider using it in your coffee.
2. Consider intermittent fasting – start by fasting 12 hours and eventually build up to 24 hours. You might be surprised at how much more energy you have and it lets your digestive system rest. This includes your pancreas where insulin is created.

Prevention of Prediabetic Neuropathy

Preventing prediabetic neuropathy involves a proactive approach to maintaining stable blood sugar levels and leading a healthy lifestyle. Making small, sustainable changes can significantly delay or even avoid the onset of neuropathy symptoms. Here are a few additional strategies to consider:

Regular Check-Ups: Routine medical screenings can help catch early warning signs of prediabetes. In addition to blood sugar and A1c tests, discuss adding insulin fasting and glucose tolerance tests with your healthcare provider if you are at risk. Early detection can give you the chance to make meaningful changes before neuropathy becomes an issue.
Focus on Weight Management: Studies show that maintaining a healthy weight is one of the most effective ways to prevent insulin resistance and manage blood sugar levels. Combining a balanced diet with regular physical activity can keep your weight in check and help prevent the progression of diabetes.

By adopting these preventive steps and being mindful of lifestyle habits, individuals can reduce their risk of developing prediabetic neuropathy and related complications.

So if you think you have prediabetic neuropathy, please consider asking for all four tests that we spoke about in this blog. It may give you the advantage of being proactive and avoid being placed on medication. You can visit our locations in Fort Collins Podiatrist in Fort Collins, Colorado and Broomfield, Colorado.

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Suffering from Nerve Pain In Your Legs at Night? Find Out Why!

Posted on July 21, 2022June 30, 2025 by admin

Unfortunately, most people reading this may experience poor sleep due to nerve pain. Difficulty falling asleep, poor sleep quality, exhaustion; these can all be factors of nerve pain at night. Not to mention the anxiousness of thinking what you’ll do the next night. Many individuals experience the pain all the way from their hips, to their feet. For some, it is an isolated feeling solely in the upper legs, ankles, or feet. But the real question is: why does this happen and what can you do about it to get a more restful night?

Why Is The Nerve Pain In My Legs Worse At Night?

Distractions
It is thought that for some, the reason could be that during your waking hours, your mind is distracted by all the things you’re doing during the day. At night these distractions go away, so now your attention is focused on the nerve pain in your legs.
Sleep Position
You may have noticed that certain sleep positions will aggravate your pain. Certain positions may aggravate pain if it is coming from your back. Certain positions may also put more pressure on locations where the nerves are damaged in the legs.
Sheets and Blankets
The pressure of sheets or blankets on the skin may also cause discomfort so reducing this pressure on the legs may help.
Temperature
Most people prefer a cool room to sleep in, but it is thought that this may contribute to nerve pain. There may be less blood flow to the nerves in the legs because of the decreased body temperature, and the coolness may make the nerves more excitable.*What Conventional Medicine Will Tell You

What Conventional Medicine Is Telling You

Sciatica
This is pain that originates from the spinal cord where the nerves that go to your legs originate. Symptoms tend to be more above the knee then below.
Nerve pain from peripheral Neuropathy
It may be burning, tingling, numbness, or pins and needles sensations that you’ll experience. Neuropathy can be associated with medical conditions such as diabetes.

Here is what 95% of you are not being told! Read further

As a peripheral nerve surgeon, I will often mention to my patients that conventional medicine is 30 years behind regarding the evaluation and treatment of the peripheral nervous system in the lower extremity. Few doctors have thorough training in this speciality, and many people are not properly diagnosed because of this. It is common to hear; “It’s irreversible, so take anti-inflammatory medications or prescription drugs.” Or, you’re told the problem comes from the back, and treatments are focused on the back only leading to physical therapy or chiropractor appointments. These often fail to address the source.

Three Nerve Tunnels In The Legs You Need To Become Familiar With To Understand The Source Of Your Leg Pain

Common Peroneal Nerve Tunnel
This tunnel is just below the knee on the outside of the leg. This nerve supplies the muscles and provides sensation to the top of the foot.
Superficial Peroneal Nerve
This nerve is a branch of the common peroneal nerve and its tunnel is on the front of the leg in the lower one third. It also supplies nerves to the top of the foot.
Soleal Sling Tunnel
This nerve lies in the upper calf just below the knee. It supplies the skin and muscles on the bottom of the foot.

So Why Could The Pain Be From These Tunnels?

Mechanical
It may be that you are born with tight nerve tunnels, just like some patients are more likely to have carpal tunnel. Patients suffering from Restless legs have a fifty percent chance of someone else in the family also having Restless legs. So tight nerve tunnels could be inherited.
Trauma
For others, something as simple as an ankle sprain could put traction on these nerves and cause chronic nerve pain.
Metabolic
If you’re diabetic because your sugars are higher, your nerves will swell causing more pressure on the nerves as they travel through nerve tunnels. So, the nerve damage is more from compression rather than the medical condition.

So, if you’re frustrated with nerve pain in your legs and you’re being told it’s your back, neuropathy, irreversible, or maybe medication is the only fix; now you know there is another solution. The source of the pain may be from one of the three nerve tunnels we have described. So if you want to improve the quality of your sleep, this blog may have opened the door to a new solution. We are here to help.

Watch Julianne explain how she finally found relief from nerve pain.

Restless Legs Syndrome Has To Do With The Brain Right? Wrong! No It’s In The Legs Where You Feel It.

Posted on December 17, 2021June 30, 2025 by admin

Many of you have been led to believe that restless legs may have to do with dopamine a neurotransmitter in the brain, or your iron levels or magnesium levels. Yes this may have a role however from my experience, the experiences of my patients along with my research point another direction, THE LEGS! Yes where your symptoms are located and where the cause is are the same. For many the nerve tunnels in the lower extremity have become to tight. The symptoms of restlessness, cramping, jerking and creepy crawley sensations then begin.

For many that first learn this its like the lights turned on. Common comments are,

“this makes so much sense” and “I knew there had to be an answer”

Have you ever wondered why few doctors do a full examination of the nerves in the lower extremity.

Often your diagnosed with Restless legs by the symptoms you share with your doctor as that is the standard of care. You may be surprised to find how little research has been done evaluating the nerves in your legs regarding your Restless legs. Currently we have one peer reviewed study to back up what I’m saying. A second study with more rigorous data will soon be submitted for publication. When everyone’s searching for metabolic problems as the issue I’m saying consider it to be a mechanical issue from compression of nerve tunnels. This has been shown to be the root cause. You may also be wondering why is a podiatrist opening the door to this new pathway. I suspect most of what you read about restless legs is coming from the Neurologists. Why aren’t they talking about this? Most doctors have been poorly trained in the evaluation and treatment of the peripheral nerves in the lower extremity so the pathway to this discovery you may find interesting. Like so many revolutionary changes it took people on the outside looking in and saying “have we ever considered this?” Its an area of medicine that’s been ignored and it’s time that you consider the peripheral nerve tunnels in your legs as the problem.

To learn more you may want to consider reading my Amazon best seller book , A Perfect Nights Sleep. Also consider visiting my website, reviewing my research paper, or consider giving us a call .

Five Stages of Peripheral Neuropathy and How to Cure the Nerve Damage

Posted on December 14, 2021July 1, 2025 by admin

Have you heard these comments regarding peripheral neuropathy?

“The nerve fibers have disintegrated so they are permanently damaged, it’s irreversible.” “There is no cure.” Listening to this, you walk away from whichever doctor told you this and you say to yourself “Oh well, I guess the nerve damage is permanent and there is nothing I can do to change that.” Typically, if your neuropathy is severe, you may walk away from this healthcare encounter with a prescription of Lyrica, Gabapentin, or a Narcotic. In this blog we talk about your treatment options and the different stages of peripheral neuropathy.

Challenging what conventional medicine is telling you because it is false! It’s not true!

Aside from treatments aimed at reducing carbohydrate and sugar intake in your diet or looking at vitamin deficiencies; current medical treatment involves two options, however, there is a third option that very few of you hear about.

Option 1 -The problem is metabolic.

It may be from diabetes or if one is prediabetic. It could be from an autoimmune disease, alcoholism, thyroid condition, or an unknown cause. Therefore, the nerves are damaged and just don’t work well.

Option 2 – The problem starts in the back.

So the back needs to be addressed. Maybe, you see a chiropractor, get injections in your back, go through surgery on your back, or use nerve stimulators or pain pumps in your back.

Option 3 – The problem is mechanical and it is in the foot and legs.

To understand this option, we must look elsewhere at the upper extremities, hands, and arms. When burning, tingling and numbness occur, doctors are trained to consider nerve tunnels such as the carpel tunnel. They are looking for a mechanical problem. Could there be a tight nerve tunnel that is compressing the nerve, and if so surgery to open the nerve tunnel would be considered. This may occur in both diabetic and non-diabetic neuropathy. Our research provides objective evidence of this. (Ref, Anderson ¹, Yamasaki ²) The nerves can be damaged from metabolic processes but there’s another solution to fix the problem. Very few doctors have been trained to evaluate and treat nerve pathways in the lower extremities. So, surgical treatment must be considered in the five stages to save lives and limbs, especially when one has a diabetic condition. It may even have a positive effect on blood vessels. In the diabetic state, it is known that because of high sugar levels, the body produces a sugar by-product called sorbitol. This sugar will reside in the nerve tissue and will attract water to the nerve causing swelling. Now with a larger nerve, the nerve tunnels that the nerve branches pass through become tighter. (Ref D Lee; D Dauphinée, J. Jakobsen ³, J. Jakobsen ⁴. With this information in mind, it is ideal to consider surgical decompression to relieve pressure on the nerve.

So here are the stages of peripheral neuropathy and what to do

First Stage – In this stage of peripheral neuropathy, the symptoms of burning tingling, and numbness may be very inconsistent and sporadic. The intensity of the burning, tingling, and numbness in the feet or the legs comes and goes. At this stage, looking at the possibility of being prediabetic is important, and nutritional modifications may have a significant impact

Second Stage – The symptoms will now be getting more intense and frequent. Patients are more concerned and may be more likely to seek treatments. At this stage, nutrition considerations are still useful and consultation with a peripheral nerve specialist should be considered to address surgical or non-surgical options.

Third Stage – This is when the symptoms will peak. At this stage, the symptoms may be 24/7 and it may become difficult to sleep comfortably, and walking may be more difficult because of the pain. Many patients may consider medication such as Gabapentin or Lyrica or even pain medication or narcotics. At this stage, nutritional options will have less impact and the option for surgical decompression should be considered. When symptoms are the worst, surgery may be more impactful.

Fourth Stage – In this stage, the severity of the pain and burning may decrease, and walking may now be affected by numbness and weakness. With balance and reflexes being affected, concerns about using a cane or walker are common. In diabetics, the risk of an amputation starts to go up. At this stage, nutritional options do not help that much, and surgical options may still be considered. Now the risk of amputation in the diabetic becomes more real.

Fifth Stage – At the final stage, the nerve is very damaged and there is little pain. The feet will be number and weaker. Walking becomes more challenging and in diabetics, the risk of amputation is more common. This is the stage of peripheral neuropathy where amputations are most likely to occur. Surgery may still be entertained, but it may not be as effective as if it had been performed in stage three or four.

In summary, consider the following when dealing with different stages peripheral neuropathy

Get treatment early to know if you have neuropathy in early stages one and two. Addressing it nutritionally may also have more impact. For most types of neuropathies, you should be evaluated for nerve compression by stages two or three. Especially in diabetics, at the stage where you’re contemplating medication, nerve decompression surgery should be considered. Rather than being medicated through the most painful stages of peripheral neuropathy, patients may want to consider the surgical option of treatment to maximize potential reversal of nerve damage. Waiting till stages four or five may limit the potential improvement gained by surgical decompression. By addressing stages two and three the potential to avoid amputation, limb loss, and possible death could be reduced in diabetics. In summary, as more patients are learning about nerve compression in the lower extremity, the health risks can be eliminated especially in those suffering from diabetic neuropathy.

Anderson JC, Nickerson DS, Tracy BL, Paxton RJ, Yamasaki DS. Acute Improvement in Intraoperative EMG Following Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: 1. EMG Results. J Neurol Surg A Cent Eur Neurosurg. 2017 Sep;78(5):419-430. doi: 10.1055/s-0036-1593958. Epub 2016 Dec 30. PMID: 28038479. https://pubmed.ncbi.nlm.nih.gov/28038479/
Yamasaki DS, Nickerson DS, Anderson JC. Acute Improvement in Intraoperative EMG During Common Fibular Nerve Decompression in Patients with Symptomatic Diabetic Sensorimotor Peripheral Neuropathy: EMG and Clinical Attribute Interrelations. J Neurol Surg A Cent Eur Neurosurg. 2020 Nov;81(6):484-494. doi: 10.1055/s-0040-1701619. Epub 2020 May 26. PMID: 32455446. https://pubmed.ncbi.nlm.nih.gov/32455446/
Lee, D., & Dauphinée Damien M. (2005, September 1). Morphological and functional changes in the diabetic peripheral nerve using diagnostic ultrasound and neurosensory testing to select candidates for nerve decompression. Journal of the American Podiatric Medical Association. https://meridian.allenpress.com/japma/article-abstract/95/5/433/156230/Morphological-and-Functional-Changes-in-the
Jakobsen, J. (1978, February 1). Peripheral nerves in early experimental diabetes – diabetologia. SpringerLink. https://link.springer.com/article/10.1007/BF01263449

Frequently Asked Questions (FAQs) About Stages of Peripheral Neuropathy

What is neuropathy and what are its symptoms?
Neuropathy, also known as peripheral neuropathy, involves damage or dysfunction of the peripheral nerves, leading to symptoms like numbness, tingling, burning sensations, and pain typically in the hands and feet.
What causes neuropathy?
Various factors can cause neuropathy including diabetes, chemotherapy, certain infections, and physical injuries. Each type has its own specific causes and risk factors.
Are there different types of neuropathy?
Yes, there are more than 100 types of peripheral neuropathy, each characterized by the specific nerve types involved and the symptoms presented.
How is neuropathy treated?
While there is no cure for neuropathy, treatments are available that focus on managing symptoms and underlying conditions. These can include medications, physical therapy, and in certain cases, surgical options like nerve decompression surgery.
What are the long-term impacts of neuropathy?
Neuropathy can be a chronic condition with symptoms that vary in severity. Long-term impacts might include persistent pain, increased sensitivity to touch, and potential mobility issues due to muscle weakness or coordination problems.