Preventing Diabetic Foot Complications: Tarsal Tunnel Decompression for Compressive Neuropathy

Abstract

Background: Diabetic foot complications, particularly ulceration and amputation, pose a significant public health burden in Bangladesh. While diabetic peripheral neuropathy (DPN) is the primary cause, a superimposed, surgically correctable compressive neuropathy at the ankle, Tarsal Tunnel Syndrome (TTS), is often an overlooked yet critical factor. Objective: This study aimed to evaluate the efficacy of Tarsal Tunnel Decompression (TTD) in preventing major foot complications in a high-risk Bangladeshi population. Methods: A prospective, multi-centre comparative study was conducted in Dhaka, Bangladesh, involving 120 patients with Type 2 Diabetes, symptomatic DPN, and a positive Tinel's sign. Patients were allocated into two groups: 60 patients underwent TTD, and 60 patients received enhanced standard medical care (control). The primary outcomes were the incidence of new or recurrent foot ulcers and major amputations over a 24-month follow-up period. Secondary outcomes included pain relief (Visual Analogue Scale) and restoration of protective sensation. Results: The TTD group demonstrated a significantly lower incidence of new or recurrent foot ulcers compared to the control group (5.0% vs. 28.3%, p<0.001). The rate of major amputation was also substantially lower in the surgical group (1.7% vs. 15.0%, p<0.01). Furthermore, 91.7% of patients in the TTD group regained protective sensation, compared to only 6.7% in the control group (p<0.001). The surgical group also experienced a profound reduction in neuropathic pain, with mean VAS scores decreasing from 7.2 to 1.5, a significantly greater improvement than that seen in the control group (p<0.001). Conclusion: Tarsal Tunnel Decompression is a highly effective surgical intervention that dramatically reduces the risk of ulceration and amputation in diabetic patients with evidence of superimposed nerve compression.