The most common of the many complications of diabetes is diabetic neuropathy. Neuropathy can occur despite good glycemic control. As the disease progresses, neuropathy will occur in 30-85% of patients. Once diabetic neuropathy occurs, it can gradually worsen. The pathogenesis is not fully understood and there is no way to prevent it from occurring. 1. Why are peripheral nerves compressed in patients with diabetic peripheral neuropathy? The peripheral nerve starts in the spinal cord and innervates the fingers and toes. In this pathway, there are multiple anatomical narrowings. In diabetic patients, the peripheral nerves are swollen. So it is conceivable that if the nerve is swollen at one anatomical stenosis, then the nerve will be compressed and produce symptoms. The second is that as early as 1979, it was reported that paracrine axoplasmic transport in the nerves of diabetic patients was dysfunctional. This means that damaged nerves in diabetic patients have difficulty repairing themselves, so peripheral nerve compression makes it difficult for the nerve to repair and produce symptoms as a result. The relationship between neuropathy and nerve compression: The relationship between neuropathy and nerve compression is that certain metabolic abnormalities in diabetic patients lead to neuropathy, and neuropathy creates the conditions for the occurrence of nerve compression. This means that at some stage of the disease process, neuropathy and neurological compression are co-existing, but the symptoms may be due to neurological compression. 3. Surgical approach? Peripheral nerve decompression is a procedure often performed to treat nerve compression and to restore sensation and muscle strength. The surgery can be performed on the arms, hands, legs and feet by cutting through ligaments or fibrous tissue to release the compressed areas of the nerve pathway. This relieves the pressure on the nerve, improves the blood supply to the nerve, and allows the nerve to glide with the movement of the adjacent joint. 4. Why does surgery help improve nerve symptoms? Peripheral nerve decompression does not resolve neuropathy due to abnormal diabetic metabolism. However, if decompression is performed at an early stage of nerve compression, blood flow to the nerve can be restored, symptoms of numbness and tingling can disappear, and muscle strength can be restored. If decompression is performed at a late stage of nerve compression, decompression can help regenerate the nerve even though the nerve fibers have begun to die by this time. If you wait until the lesion is very advanced to have the surgery, it is very difficult to recover. If you already have an ulcer on your foot or have had a toe amputation as a result, it is basically impossible to recover because the damage to the nerve is irreversible at that point. 5.What are the risks of surgery? The main risks are bleeding, infection, scar formation, worsening of symptoms during nerve regeneration and delayed wound healing. 6.What are the chances of success of the surgery? The results of this surgery have been carefully analyzed over the past 15 years. The results of several independent studies were published in succession between 1992 and 2000. These trials yielded the same results: overall, 85% of diabetic patients who underwent this nerve decompression had reduced pain and improved sensorimotor and balance abilities. 78% of patients with lower extremity nerve involvement had improved sensory function. Of course, just because you have an ulcer or missing toe does not mean that you are out of the running for surgery. A definitive determination can only be made after a visit to the clinic. A post-operative patient survey found that none of the patients were hospitalized for foot infections or ulcers, none had amputations, and none had hip fractures due to falls.