Nerve decompression surgery for diabetic neuropathy: does it work?

If you have diabetes and your feet burn, tingle or feel numb, you have probably been told it is neuropathy and that you will have to live with it. Pills may take the edge off, but often not enough. Then you see the phrase “nerve decompression surgery” and wonder if it could work for you. The honest answer is that it can, for the right person. This article explains who that person is and what the trials found.

What is nerve decompression surgery for diabetic neuropathy?

Diabetic neuropathy is nerve damage from diabetes. It usually starts in the toes of both feet.^[6] Diabetes also makes nerves swell, and a swollen nerve can get trapped where it passes through a narrow space.^[7]

Decompression surgery opens those tight spots. In the Dutch trial, surgeons released four nerves in the leg: the tibial nerve behind the inner ankle (tarsal tunnel), the common peroneal nerve at the outer knee, and the deep and superficial peroneal nerves on the front of the ankle and top of the foot.^[8] The goal is to treat the trapped nerve sitting on top of the neuropathy, not the neuropathy itself.

Dr. Efe Ozturk, a double board certified Foot and Ankle Surgeon and podiatrist, evaluates people with diabetes for trapped nerves and performs nerve decompression for appropriate patients.

Does nerve decompression surgery work for diabetic neuropathy pain?

For people with signs of a trapped nerve, randomized trials say it can. A randomized trial assigns people to treatments by chance, which makes it a fairer test.

• The Dutch trial. In 42 people, surgeons decompressed one leg and left the other as a comparison. At 12 months, pain in the operated leg averaged 3.5 out of 10, versus 5.3 in the other leg. About a third of those who improved had a drop of more than five points.^[2] A drop of 2.9 points or more, enough for people to notice a real difference, was reached by 42.5%.^[8]
• A pragmatic trial. In 22 people randomized to surgery or watching, the surgery group had more than three times the odds of rating their pain as better at one year.^[9]
• The sham-controlled trial. In the Diabetic Neuropathy Nerve Decompression (DNND) trial, 78 people who had failed a year of medical treatment were randomized. Those who had surgery reported much lower pain than those who were only observed, at 12 months and again at 56 months. At 12 months the sham-operated leg had improved as much as the released leg, but by 56 months the released leg had less pain.^[4]

Large case series point the same way. In 628 people with a positive tap test at the ankle, average pain fell from 8.5 to 2.0 at six months and stayed there for 3.5 years.^[10] In 60 people treated in a Dutch university clinic, quality of life and neuropathy symptom scores both improved about a year after surgery.^[11]

Can decompression lower the risk of ulcers and amputation?

This is where some of the most striking numbers are, though they come from studies without randomization, and the international diabetic foot guideline does not recommend decompression to prevent ulcers.^[5]

• In 42 people who had healed a foot ulcer, ulcers came back in 4.8% of operated legs over three years, versus new ulcers in 21.4% of the unoperated legs, which needed three amputations.^[12]
• In a cohort of 65 people with past ulcers, 12% of operated legs ulcerated again over an average of almost five years, versus 30% of the other legs, three of which went on to amputation.^[13]
• In 50 people followed for an average of 4.5 years after one-leg surgery, no ulcers or amputations occurred in the operated legs. The other legs had 12 ulcers and 3 amputations.^[14]
• The 2025 pooled analysis found fewer repeat ulcers and fewer amputations after surgery.^[3]

A trapped tibial nerve may matter even without surgery. In people with diabetes followed for a median of 836 days, those with tarsal tunnel syndrome in both feet developed ulcers about twice as often as those without it, 17.4% versus 8.3%.^[15] If you already have ulcers, our main practice provides diabetic foot care (external site).

Who is a good candidate?

The studies with good results selected people with signs of a trapped nerve, most often a positive Tinel sign. That is a tingle or zing when the nerve is tapped.^[2,10] In a Dutch study, a positive tap test over the tibial nerve at the inner ankle was found in 44.9% of people with diabetes versus 26.5% of people without it, and those nerves had more symptoms and less feeling.^[1]

Other things that point toward a good result:

• Less severe nerve damage before surgery. In five-year follow-up of the Dutch trial, people with severe loss of feeling did worse. Age, how long you’ve had diabetes and body weight also affected results.^[16]
• A trapped nerve seen on ultrasound. In 107 people, pain at least halved at 12 months in 83.3% of those with a trapped nerve on ultrasound, versus 64.6% of those without one.^[17]
• Pain that medicine hasn’t controlled. The sham-controlled trial required a year of failed medical treatment, and the Dutch authors suggest surgery for people whose pain medicine isn’t enough.^[4,8]

Your exam guides the plan. We map feeling in each nerve’s area, test strength, tap along each tunnel and check circulation. If nerve studies (EMG and nerve conduction) or imaging are needed, they are arranged with another specialist. See common peroneal nerve compression and peripheral neuropathy.

What are the limits?

The evidence is real but not settled. In the sham-controlled trial, the released leg and the sham leg improved equally at 12 months, and the authors said a placebo effect, improvement from expecting to get better, may explain part or all of the benefit.^[4] A 2026 review of seven randomized trials found less pain but a high risk of bias, no trial evidence for better feeling, balance or ulcer healing, and wound problems in 23.9% of surgical patients. It called the surgery investigational.^[18] In the Dutch trial, surgery didn’t change nerve test results or overall quality-of-life scores at one year.^[19,8] The American Academy of Neurology in 2006 and a Cochrane review in 2008 called decompression for diabetic neuropathy unproven.^[20,21] The 2023 international diabetic foot guideline suggests not using it to prevent foot ulcers.^[5] A large Dutch randomized trial comparing surgery with non-surgical care was designed to answer these questions; its plan was published in 2020.^[7]

So we do not offer decompression as a treatment for neuropathy itself. When you have neuropathy and clear signs of a trapped nerve, we assess that nerve on its own merits and talk through what the evidence shows.

Common questions

Does neuropathy treatment work?

Medicines help some people. In a 2026 JAMA review, pain fell by at least half in 38% of people with painful diabetic neuropathy taking 1,200 mg of gabapentin a day, and pain often persists despite medicines.^[6] When a trapped nerve adds to the pain, releasing it is another option.^[2]

Can neuropathy in the feet be reversed?

Complete reversal of nerve damage is uncommon.^[6] Read can peripheral neuropathy be reversed? for the cause-by-cause answer.

Is burning pain in the feet a sign of a trapped nerve?

It can be either. Burning is the most common pain word people with painful diabetic neuropathy use.^[22] A zing when the nerve at the inner ankle is tapped is a valid sign of a trapped tibial nerve.^[1]

Where can I get foot numbness treatment in NJ?

We see patients in Lyndhurst, Paramus and Millburn. Please call our office at 908-215-5953 to inquire about your insurance.

When to see a specialist

Book an evaluation if your feet burn, tingle or feel numb despite medicine, if one foot is worse, or if a spot zings when tapped. Bring a list of your medicines and your latest A1c.