Surgical Decompression for Diabetic Neuropathy in the Foot

Inclusion criteria

• Age >18 years
• Presence of Type 1 or 2 diabetes mellitus (fasting plasma glucose > 7 mmol/L or casual plasma glucose > 11.1 mmol/L and symptoms of diabetes or a 2hr plasma glucose in a 75g oral glucose tolerance test > 11.1 mmol/L)
• Symptoms of paresthesias (including burning pain) or numbness present symmetrically in both feet, determined to be on a peripheral nerve basis
• Total Neuropathy score of ≥ 2 based on symptoms, signs, and nerve conduction study abnormality
• Average pain on Likert scale (range 0 - 10) ≥5
• Good diabetic control with Hgb A1C < 8
• Presence of Tinel's sign at the Tarsal Tunnel
• Possession of valid Ontario Hospital Insurance Plan (OHIP) coverage

Exclusion criteria

• Other types of diabetes mellitus (gestational, drug-induced, etc.)
• Other cause of neuropathy than diabetes such as vasculitis, amyloidosis, toxic neuropathy, HIV, renal failure, alcohol abuse, etc. Pure entrapment neuropathy without evidence of DSP
• Symptomatic lumbosacral spine disease
• Symptomatic lower extremity vascular disease
• Previous foot ulceration or amputation. Other contraindications to surgery such as significant ankle edema, venous stasis, morbid obesity, or previous surgery/injury which would be incompatible with appropriate wound healing
• History of Peripheral Arterial Disease
• HbA1c > 8.0 - Adults lacking capacity to consent, pregnant women, prisoners, non-English speakers who require an interpreter, and those unwilling or unable to participate in the full study follow-up