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To deliver trusted solutions, the medical field rarely strays from traditional procedures, but treatments created over 50 years ago should be scrutinized to ensure they match the current medical landscape. Patients should challenge conventional neuropathy wisdom by demanding foot and ankle surgeons to prioritize nerve preservation for neuropathy instead of discarding a small, but meaningful part of anatomy that can be saved.

Alan Shih
Alan Shih Alan Shih

Medical doctors are taught that neuropathy is irreversible and progressive in nature, and there is no viable treatment for these damaged nerves. When treatment is offered, it's usually in the form of medication often used for depression and seizures.

Among foot and ankle surgeons, nerves are truly the bastard child compared to other structures such as bones and tendons. While no surgeon will overtly say they destroy nerves, very little care is given to them. Pinched nerves located between the 3rd and 4th toe happen often and cause painful sensations, but instead of understanding why the pain is happening, surgeons prefer to cut out the problem.

When doctors aren't cutting out and throwing away nerves in the foot, they may be freezing (cryoablation) them or putting alcohol on them (poisoning). Instead of preservation and improvement of function, we are utilizing a corrosive and scar-producing alcohol solution that deadens these nerves. When freezing nerves to death, circulation in this region is also destroyed because blood vessels run along with the nerve.

By killing nerves, a patient's pain may stop, but it removes sensation in that area too. Doctors play this off as unimportant because only a small part of feeling is lost in the foot. Although this is true, it makes much more sense to practice procedures that return a foot to their original state rather than permanently damaging them.

No hand surgeon would find it acceptable to cut out a nerve in the wrist because doctors know motor ability is at risk of being lost. Therefore, it's an unacceptable solution to discard damaged nerves since higher dexterity is important for wrist and hand functionality. Hand surgeries often focus on alleviating a constricted area by releasing tissue pinching the nerve without any harmful action taken. This process preserves nerves, improves function, and relieves symptoms such as numbness and burning.

Yet in foot and ankle surgeries, numerous neuromas (nerves in the foot) are cut out and discarded every day. We've been conditioned to practice this destructive method for decades despite the similarities between hands and feet that call for replicated treatment. Why is it acceptable to kill nerves in the foot when it's unheard of for hand surgeons?

Unfortunately, modern foot and ankle surgery isn't fond of treatments that focus on nerve preservation. Opting for destructive procedures, because its status quo, and not challenging the grain of normal medical care.

However, scarring of nerves called stump neuromas can form after nerves are killed and eventually create more pain than the original issue. After a nerve is cut out, they attempt to regenerate, albeit very slowly, these nerves can become painful after numerous years. Doctors wouldn't like to admit that this happens more often than it should because poisoning, freezing, or cutting out nerves is a standard procedure. Stump neuromas don't always form, but once present it becomes difficult to treat.

If you've seen your doctor and have been told the conventional response that nothing can be done, I encourage you to advocate for your health. Most doctors are well intentioned, but they simply don't know surgical nerve anatomy well enough to consider other treatments for neuropathy. Being your own advocate can be intimidating since you'll have to nudge doctors about what you prefer. However, if the doctor doesn't agree, seek out other professional opinions and choose what's right for you.

I want to be an advocate for my patients because as a doctor, I feel uncomfortable about these destructive surgeries being done on their body when another option is available that circumvents the loss of sensation, even if it's only in a minute area. Most patients aren't knowledgeable about what else can be done because medicine is often presented as black and white in its solutions. Alternative methods are viewed as unreliable and unscientific, but this perspective limits patients' access to treatment that might suit them better.

Drawing awareness and educating patients on how preserving nerves can alleviate their neuropathy symptoms will increase doctors' likelihood to adopt this procedure and drive innovation that's been overlooked in foot and ankle surgery. On a broader scale, I hope these effects spread to other areas of medicine so improvements in historically performed procedures can be modernized to increase satisfaction for patients worldwide.

Dr Alan Shih is CEO of Head to Toe Healthcare, PLC