11/16/2021    Peter J. Bregman, DPM

Nerve Surgery and Non-Weight-Bearing

I am writing this email as former president of the
AENS and as someone who has performed over 500
tarsal tunnel surgeries. I have be privy to many
patients with failed initial tarsal tunnel releases
and almost all of them have something in common.
They were told by their surgeon to be non-weight-
bearing for more than a week, some for a month or
more. This makes no scientific or medical sense.

The nerves must glide and move as soon as possible
after the surgery to prevent NOT cause the nerves
to get stuck in the scar that all surgeries form.
Yes, 20-40 years ago and more the protocol was 3-4
weeks NWB and that is why the success rates were
50-70-%. Now with better technique, and
understanding of the role of the distal release,
the success rate is 85-90%.

Also, it seems some people still think this is a
“rare” condition? It is not rare and more common
than most think, especially by most neurologists.
There are many cases of plantar fasciitis that are
incurable or last for years. Most of these are
undiagnosed tarsal tunnel. The old literature is
wrong and so are the protocols. The AENS is
dedicated to providing physicians with the current
knowledge of peripheral nerve issues both diagnosis
and treatment.

I would be remiss if I did not mention that
surgeons also need to really question the idea of
performing a neurectomy of a Morton’s nerve
entrapment before trying a nerve decompression.
Many surgeons will “try” some decompressions
without using proper techniques and not have the
success rates of AENS trained surgeons and say it
doesn’t work as well as it is being reported. This
is not the way. Stump neuromas happen more than
people think. Please learn more peripheral nerve so
patients receive the best practices.

Peter J. Bregman, DPM, Las Vegas, NV

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