Peripheral Neuropathy

Peripheral nerve problems impact many segments of the population. “Peripheral” simply means outside of the spinal cord and brain, which house the “Central” nervous system. Neuropathy of the peripheral nerves encompasses pain, weakness, and/or numbness, and/or tingling from nerve damage often in the hands and feet. It is often caused by diabetes, chemotherapy or other medications, but often a specific cause cannot be found.

More than 100 types of peripheral neuropathy exist, each with its own symptoms and prognosis. Symptoms vary depending on the type of nerves — motor, sensory, or autonomic — that are damaged.

Without diagnosis and treatment, the nerve damage can blunt sensation. This can lead to small injuries developing unnoticed leading to ulcers and infections which can cause tissue death (gangrene), and infections, often requiring amputation.

Treatment is based on the type of nerve damage, symptoms, and location. With proper education, some people can minimize and manage symptoms with lifestyle changes and/or medications. Those with chronic neuropathic pain often focus treatment on addressing the pain rather than the underlying cause as few types of neuropathy have the potential to be fully cured.

Nerve Decompression Surgery

Dr. Wolfort is one of only a few surgeons in the country performing Nerve Decompression Surgery to improve neuropathy of the lower extremity. Similar to carpal tunnel syndrome surgery, this procedure involves the decompression of nerves in the leg, ankle, and foot of those experiencing nerve entrapment. It helps improve symptoms of diabetic peripheral neuropathy of the foot by allowing select nerve fibers to slowly regenerate and return to activity, often preventing amputation.

Candidates for nerve decompression surgery receive a number of tests prior to surgery to determine their vascular status and degree of nerve damage and its source. Complications rates are minor and patients are walking within several days following lower extremity procedures.

Morton’s Neuroma

Morton’s neuroma is a painful condition that affects the ball of the foot, most commonly impacting the area between the third and fourth toes. Called an intermetatarsal neuroma because of its location between the metatarsal bones, the condition requires treatment as it will not disappear on its own. Morton’s neuroma is a benign but painful condition that affects the ball of the foot.

Symptoms often come and go depending on how much time you spend on your feet. A full and accurate diagnosis is essential to determine what is causing the neuroma. Morton’s neuroma generally responds well to conservative treatments such as icing the foot, massage, and physical therapy. For resistant cases, injections and/or surgery is required.

Carpal tunnel syndrome

The carpal tunnel is a narrow passageway in the wrist that protects the median nerve and flexor tendons that bend the fingers and thumb. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes pressed or squeezed at the wrist.

Symptoms, which often first appear in one or both hands during the night, since many people sleep with flexed wrists, start gradually and can include burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers.

As symptoms worsen, people might feel tingling during the day, decreased grip strength and an inability to form a fist. If left untreated, the muscles at the base of the thumb may waste away and a loss of sensation may occur.
A very common and treatable condition, CTS should be addressed by a physician as early as possible and underlying causes such as diabetes or arthritis should be treated first. During the early stages, non-surgical treatments can include:

  • Splinting
  • Avoiding activities that may provoke symptoms
  • Over-the-counter medications
  • Prescription medicines such as prednisone or lidocaine

Should surgery be required, carpal tunnel release is one of the most common procedures and involves addressing the ligament to relieve pressure on the nerve.