Diabetic peripheral neuropathy (DPN) is the most common chronic complication in diabetic patients, with a prevalence of 60% to 90%. The pathogenesis of DPN is not fully understood, so there are no effective preventive measures. Treatment is also based on pharmacological treatment, including blood glucose control, analgesia, and neurotrophy. In the past, surgical treatment was limited to ulceration and amputation, but in the past 20 years, some foreign scholars have carried out and promoted the use of multiple peripheral nerve decompression to treat DPN, and achieved good results. Recently, we successfully completed a case of common peroneal nerve and posterior tibial nerve decompression for diabetic peripheral neuropathy of the lower extremity with satisfactory results, which is reported as follows: 1. The patient had numbness in the left foot with no obvious cause one month ago, mainly below the left ankle joint, accompanied by spontaneous pain in the left calf, which was pins and needles-like and burning-like, and heavy at night. He had been suffering from type II diabetes mellitus for 8 years and had been taking euglycemia regularly for a long time, with fasting blood glucose controlled at about 7 mmol/L and 2 hours postprandial blood glucose controlled at about 9 mmol/L. He was admitted to the hospital for physical examination: pain and mild hyperalgesia below the left ankle joint with a glove-like distribution; two points of discrimination: 8cm on the left plantar, 2cm on the right plantar, 5cm on the left lateral calf, 1.5cm on the right lateral calf, 4cm on the left medial calf and 1.5cm on the right medial calf; visual analog scale (VAS) score of 7 to 8; bilateral dorsalis pedis Bilateral dorsal foot artery and posterior tibial artery pulsations were present, and no skin ulcers on the foot were observed. The nerve conduction velocity (NCV) showed a significant decrease in the amplitude of the left peroneal nerve potential; the sympathetic skin response (SSR) showed an abnormal response in both feet; the electromyologram (EMG) and somatosensory evoked potential (SEP) The electromyologram (EMG) and somatosensory evoked potential (SEP) were normal. 2. Surgical method: General anesthesia was chosen, and the left common peroneal nerve and left posterior tibial nerve were selected for decompression according to the patient’s symptoms. The patient was placed in the supine position, and after routine disinfection and towel laying, a tourniquet was driven to expel blood, and the tourniquet pressure was set at 200 mmHg for 60 minutes. The left common peroneal nerve was first decompressed by making an oblique incision 2 cm below the small head of the left fibula, and the skin and subcutaneous tissues were incised to reveal the common peroneal nerve. The skin and subcutaneous tissues were incised to reveal the common peroneal nerve. The outer membrane of the nerve was released along the long axis of the common peroneal nerve. Then, the left posterior tibial nerve was decompressed by making a curved incision below the left medial ankle condyle, about 5 cm long, and cutting the skin and subcutaneous tissue to separate and cut the flexor support band compressing the left posterior tibial nerve. The posterior tibial nerve is divided distally into the medial plantar nerve, the lateral plantar nerve and the radicular nerve. The left posterior tibial nerve and its branches are separated along the left posterior tibial nerve, and any fascia and tendons compressing the surface of the nerve are cut, and the outer membrane of the nerve is released along its long axis. After complete release of the nerve, the tourniquet was released to tightly stop bleeding, and the skin was closed with interrupted red tape sutures. 3. Results The patient felt pain relief in the left lower limb on the first day after surgery, with a VAS score of 0 and no significant improvement in numbness. On the third postoperative day, the numbness of the left lower extremity was gradually reduced, and the numbness disappeared one week after surgery, and physical examination showed that the superficial sensation of the left lower extremity was basically normal, and the two points of discrimination were: 1.5 cm of the left plantar, and 2 cm of the left medial and lateral calf. II. Discussion and literature review DPN is a common complication of diabetes mellitus and one of the most important causes of peripheral neuropathy, which seriously affects the quality of life of patients and even leads to foot ulcers that do not heal over time and are amputated. It has been reported that when type II diabetes is first diagnosed, up to 10% of patients can be found to have DPN if they are examined carefully, and with the prolongation of the disease, the prevalence of DPN increases year by year, with an annual incidence of about 2%. The sensory symptoms of DPN are mostly spontaneous limb pain, which is more severe at night, accompanied by numbness, nociceptive hypersensitivity and hyperalgesia; the motor symptoms are weakness of the limbs, inflexibility of fine movements and unstable gait dragging. As the damage of DPN is axon length-dependent, the more distant from the starting point, the more likely it is to be damaged, so the symptoms tend to be more severe in the distal extremities, and the sensory impairment is distributed in a glove-sock-like pattern. Some neurophysiological examination techniques can provide some objective basis for the early diagnosis of DPN, such as NCV, SEP, EMG, SSR, quantitative sensory testing (QST), etc. Among them, SSR and QST are more sensitive to lesions of small nerve fibers and are valuable diagnostic methods for early and subclinical DPN. The SSR and QST are more sensitive to lesions in small nerve fibers and are valuable diagnostic methods for early and subclinical DPN. In this case, although the patient only showed signs and symptoms of the left lower extremity, SSR showed abnormal response in both feet, suggesting subclinical DPN in the right lower extremity. The pathogenesis of DPN is complex and not yet fully understood, and its development is mainly influenced by two factors, namely, blood supply disorders and pathophysiological changes within neurons or nerve fibers due to hyperglycemia. Dellon proposed the theory of “double compression” based on the pathogenesis of DPN, that is, in the pathway of peripheral nerves starting from the spinal cord and innervating the fingers and toes, there are multiple physiological anatomical narrowings, such as ulnar canal, carpal tunnel, parapatellar and tarsal canal, etc. In diabetic patients, hyperglycemic metabolism can cause nerve swelling, causing the diseased nerve to become stuck in the anatomical narrowing site This leads to clinical symptoms in patients with DPN. Accordingly, he proposed surgical dissection of tendons, ligaments or fibrous tissues to release anatomical stenoses in nerve pathways, decompress multiple peripheral nerves subject to entrapment, improve blood supply to nerves, and increase nerve compliance to achieve effective pain relief and improve limb numbness. Its surgical efficacy has been confirmed by several animal experiments and clinical studies, and it is a promising new approach for the treatment of DPN. Peripheral nerve decompression has been reported to provide pain relief and sensory improvement in approximately 80% to 90% of DPN patients, and the earlier the treatment, the better the postoperative functional recovery. In a study of 50 unilateral operated patients with long-term follow-up, it was found that none of the operated limbs had ulcers or amputations, while 12 of the non-operated limbs had ulcers and 3 had undergone amputations, suggesting that peripheral nerve decompression can alter the natural course of DPN and reduce the incidence of ulcers and amputations. The effectiveness of this procedure was also demonstrated in this case. In conclusion, peripheral nerve decompression provides an effective treatment for DPN, but since this work is still in its infancy, it is necessary to further increase the number of surgical cases and long-term follow-up time to further determine its efficacy, and further research is needed on the surgical technique and efficacy evaluation index.