Some pretty bold claims were made on altering the natural history of the diabetic foot in this paper: Changing the Natural History of Diabetic Neuropathy: Incidence of Ulcer/Amputation in the Contralateral Limb of Patients With a Unilateral Nerve Decompression Procedure (Ann Plast Surg. 2004 Dec;53(6):517-522 Aszmann O, Tassler PL, Dellon AL.). The authors claims that "decompression of lower extremity nerves in diabetic neuropathy changes the natural history of this disease, representing a paradigm shift in health care costs. " All this based on being able to help diabetic neuropathy with decompression surgery. Given that the etiological pathways of diabetic foot complications are so multifactorial - especially the role of vascular disease in amputations, I can't see how improving one factor represents a "paradigm shift". Dr Dellon is doing some good work and has a number of publications on decompression surgery to relieve pressure on nerves in those with diabetic peripheral neuropathy.
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