Diabetic Peripheral

Neuropathy Solutions





Diabetes, which is thought to affect 400 million+ worldwide and over 37 million in the U.S. alone, is well known for causing long-term consequences throughout the body. It elevates your risk of heart disease, stroke, kidney failure, vision problems, and more. One common complication that affects your feet is diabetic peripheral neuropathy, a condition that can permanently damage nerves in your feet and ankles.

Compressions of the Lower Extremity Nerves Causing Diabetic Neuropathy


It’s a good thing nerves aren’t claustrophobic, because in many spots in the body they have to make a tight squeeze—through narrow tunnels, beneath a band of fascia, between muscles and bones, and more.

When spaces get too cramped, however, nerves can be damaged or inflamed, causing tingling, numbness, burning or shooting pain, and other issues. This is called nerve compression (or nerve entrapment), and is quite common in the fibular (peroneal) nerves of the legs and feet for a variety of reasons, including poor diet (particularly too much sugar), poor posture, repetitive injuries, and more.

Common Fibular (Peroneal) Nerve Compression

The common fibular (peroneal) nerve innervates the lateral side of the lower leg and the ankle. It leaves the sciatic nerve behind the knee, and it enters a tunnel at the lateral side of the knee, formed by the two heads of the peroneus longus muscle. It passes beneath the fibrous border of the peroneus muscle as it leaves the head of the tibia. This narrow region is where the nerve enters the front of the lower leg.

Fibular (peroneal) nerve entrapment gives sensory symptoms related to numbness or burning pain from the knee to the top of the foot, and motor symptoms that range from the leg giving out to restless leg syndrome. Compression of the fibular (peroneal) nerve branches is most commonly seen in patients with neuropathy, like diabetes, or in those who have had a knee injury or knee surgery, or who have had a sports injury like a sprained or broken ankle or knee.

The most common site of compression is at the side of the knee, where the nerve is compressed by white fascial structures against the underlying fibula bone. The fascia is released at surgery.

In the surgical treatment of nerve compression, an incision is made beneath the fibular head. (The fibula is indicated by a dashed line beneath the common fibular (peroneal) nerve and its branches).

Fascia surrounding the nerves to the lateral side of the leg is released. (The fibrous edge of the peroneus longus m. is divided and the muscle is shown slightly pulled away from the nerve at the site of incision).

Deep Fibular (Peroneal) Nerve Compression

The next most common site of compression is at the top of the foot where a small tendon compresses the deep fibular (peroneal) nerve against the underlying bone. Symptoms here are only sensory, and may feel like a knife sticking in the top of the foot, and pain between the first and second toes. This happens after a crush injury to the foot, wearing tight shoes or tightly laced boots, a broken foot bone, or foot surgery. The treatment is to remove the small tendon and decompress the nerve.

In the surgical treatment of deep fibular (peroneal) nerve entrapment in the foot, a ligament from the extensor digitorum brevis m. that crosses over the deep fibular (peroneal) nerve, putting pressure on it and causing pain, is released, as indicated by the dashed lines in the inset to the right.

Superficial Fibular (Peroneal) Nerve Compression

The least common site is in the lateral leg where the superficial fibular (peroneal) nerve can be compressed. This may occur in young athletes and require the white fascial covering of the muscles to be released. The symptoms are pain and burning on the outside of the foot while exercising. This area can be damaged in soccer or with a broken fibula or crush injuries.

Too Much Glucose Causes a Stiffening and Crust on the Outside of the Nerves

The problem is too much of a sugar called glucose in the bloodstream. Glucose changes to another sugar called sorbitol, which causes water to be drawn into the nerve (polyol pathway). The nerves then swell by 50% in the fibro osseous tunnels, the end results being a relative compression of the nerve at those “choking points.” Fluid seeps into to the nerve tissues wreaks havoc, causing them to work improperly (or not at all). In the beginning you may notice tingling or a burning sensation. Later, you may lose your ability to distinguish between sharp and dull or hot and cold. As the disease progresses, your feet will become more and more numb. Although the entire process happens gradually, usually developing and worsening over a period of several years, most of the damage is thought to be irreversible, but it is not. This is where Dr. Parker’s decompression procedures solve the problem by allowing normal nerve function to reestablish. 

Complications Can Become a Major Concern

Although pain and numbness aren’t much fun, the most significant concern for those with diabetic peripheral neuropathy is not so much the condition itself, but rather what can happen to your feet without you noticing as a result of that numbness. If you’ve lost the ability to feel friction or pain, you may not realize when you get a blister, cut, puncture wound, or in some cases even a broken bone. As you continue to walk on these injuries, or allow them to fester, ulcers and wounds can form and become infected, and injuries can cause deformities necessitating emergency care (and in extreme cases even amputation). Burns, frostbite, or prolonged exposure to dampness (which can cause bacterial and fungal infections) can also be easily overlooked.

Caring for a Foot Affected by Nerve Damage

Our office is equipped with a machine called a Doppler, which will help us quickly measure the blood flow in the feet and ankles via a non-invasive procedure. We may also try a number of other high-tech tests combined with some good old-fashioned physical examinations and talk to you about your symptoms in order to make a diagnosis.

The most important thing to remember with diabetic peripheral neuropathy is that, while most of the damage may be irreversible, you are not helpless. With our help, you possess the ability to halt the progression of nerve degradation, as well as take steps to protect your feet from subsequent damage.

The biggest and most important step: keep your glucose under control. Excess blood sugar is what causes the damage, so if you manage your diabetes well and keep your sugar within normal levels, the progression of the disease can be significantly slowed, or even halted altogether. Eat a healthy diet, get plenty of exercise, and refrain from smoking or abusing alcohol as well.

Learning How to Prevent Complications and Restore Normal Nerves

If you are already experiencing significant numbness, you’ll need to take special care to avoid injuries and, especially, the ulcers, wounds, and infections that can result from not catching them in time. Thoroughly check your feet every day (enlist a mirror or friend if need be) for cuts, scrapes, cracks, blisters, redness, swelling, or anything out of the ordinary. If you notice anything, contact Dr. Parker right away.

Going barefoot is a definite no-go for those with significant sensitivity loss. Always wear comfortable, well-fitting shoes that protect you both from exterior damage (like stepping on a sharp rock) and interior damage (like corns or blisters caused by too much friction from a shoe that’s too tight in the toe box). You may consider a pair of specially made diabetic shoes as well.

Trust One of Houston’s Top Extremity Nerve Surgeons, Dr. Robert Parker

A past president of the American Association of Extremity Nerve Surgeons, Dr. Parker has decades of experience treating cases of nerve compression throughout the legs, ankles, and feet. Our office in Houston has helped patients from around the country and the world, and can help you too. To schedule an appointment, fill out the contact form below.

Houston Office

14441 Memorial Drive, Suite #16

Houston, TX 77079

Phone: 281-497-2850

Office Hours: Monday-Friday 8:00AM to 3:00PM