Nerve Decompression for Ulcer Recurrence Avoidance (DURA)

NCT ID: NCT01762085

Last Updated: 2015-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-06-30

Study Completion Date

2016-12-31

Brief Summary

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Anecdotal reports and scientific literature suggest that the risk of recurrence of diabetic foot ulcers can be minimized by nerve decompression procedures at anatomic sites of nerve pinching and entrapment. Historical risk of 25% annually has been reported to decrease by \>80% to under 5% yearly. Since an open wound precedes the large majority (85%) of amputations in diabetes, avoidance of ulcer recurrences is important. This study tests the current academic opinion that nerve decompression will not decrease ulcer recurrence risk. Null hypothesis: nerve decompression will not decrease diabetic foot ulcer recurrence risk.

Detailed Description

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Diabetes patients with a recently healed, non-ischemic plantar diabetic foot ulcer will be randomized to "best care" standard post-ulcer treatment or to best care plus bilateral nerve decompression by external neurolysis at 4 fibro-osseous tunnel sites in the leg and foot. Comparison of the control group with standard care to the surgical intervention group will be made for subsequent appearance of a plantar foot ulcer and ulcer recurrence risks will be calculated. Additional subjective and objective secondary outcomes will be monitored. Null hypothesis: nerve decompression will not decrease diabetic foot ulcer recurrence risk.

If protection against ulcer occurrence were to be confirmed, a change in the treatment paradigm for diabetic neuropathy and foot ulcer could be appropriate.

Conditions

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Diabetic Ulcer of Plantar Aspect of Left Foot Diabetic Ulcer of Plantar Aspect of Right Foot Diabetic Polyneuropathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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healed DFU control arm

clinic-specific usual "best care"

Group Type PLACEBO_COMPARATOR

No interventions assigned to this group

healed DFU surgical intervention

clinic-specific "best care" plus nerve decompression at 4 known sites of lower leg fibro-osseous entrapment

Group Type EXPERIMENTAL

nerve decompression

Intervention Type PROCEDURE

surgical decompression involves surgical division or incision of perineural fibrous or fibro-osseous tunnel tissues which pinch, choke, compress or sharply deviate nerve trunks.

Interventions

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nerve decompression

surgical decompression involves surgical division or incision of perineural fibrous or fibro-osseous tunnel tissues which pinch, choke, compress or sharply deviate nerve trunks.

Intervention Type PROCEDURE

Other Intervention Names

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nerve release external neurolysis surgical decompression

Eligibility Criteria

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Inclusion Criteria

* Type 1 or Type 2 Diabetes Mellitus
* Diabetic sensorimotor peripheral neuropathy
* Recently healed plantar neuropathic Diabetic Foot Ulcer (\< 18 months)
* At least one palpable foot or ankle pulse or ABI\>0.8 bilaterally.
* Recent Hgb A1c \< 9.0%
* Ankle edema absent or mild

Exclusion Criteria

* Ischemic peripheral vascular disease or ankle-brachial index (ABI)\<0.8
* History of peripheral vascular arterial surgery
* History of peripheral nerve or lumbar disc surgery
* alcohol abuse(more than 2 drinks/day)
* untreated thyroid disorders
* B12 or Folate deficiency
* spondyloarthropathies
* hepatic disease
* advanced renal disease
* current lumbosacral radiculopathy or nerve compression
* toxin exposure including chemotherapeutic agents
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Association of Extremity Nerve Surgeons

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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D. Scott Nickerson, MD

Role: STUDY_DIRECTOR

NE Wyoming Wound Care Center, consultant

Stephen L. Barrett, DPM

Role: PRINCIPAL_INVESTIGATOR

Barrett Foot & Ankle Institute

Locations

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Barrett Foot & Ankle Institute

Phoenix, Arizona, United States

Site Status RECRUITING

Richard P. Jacoby

Scottsdale, Arizona, United States

Site Status RECRUITING

Southern Arizona Limb Salvage Alliance,

Tucson, Arizona, United States

Site Status RECRUITING

Andrew Rader, DPM

Jasper, Indiana, United States

Site Status RECRUITING

Damien Dauphinee

Denton, Texas, United States

Site Status RECRUITING

Maria Buitrago, DPM

Houston, Texas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Stephen Barrett, DPM

Role: CONTACT

623 572-3456

D. Scott Nickerson, MD

Role: CONTACT

307 752-9875

Facility Contacts

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Steven L Barrett, DPM

Role: primary

480-478-0780

John C Tassone, DPM

Role: backup

(602) 938-6960

Richard P Jacoby, DPM

Role: primary

480-994-5977

Manish Bharara, PhD

Role: primary

520-626-1349

David Armstrong, DPM

Role: backup

(520) 626-1349

Andrew P Rader, DPM

Role: primary

812-634-2778

Damien Dauphinee, DPM

Role: primary

940-300-3054

Maria Buitrago, DPM

Role: primary

713-680-3668

References

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Aszmann O, Tassler PL, Dellon AL. 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):517-22. doi: 10.1097/01.sap.0000143605.60384.4e.

Reference Type BACKGROUND
PMID: 15602245 (View on PubMed)

Dellon AL. Preventing foot ulceration and amputation by decompressing peripheral nerves in patients with diabetic neuropathy. Ostomy Wound Manage. 2002 Sep;48(9):36-45.

Reference Type BACKGROUND
PMID: 12271732 (View on PubMed)

Dellon AL. Neurosurgical prevention of ulceration and amputation by decompression of lower extremity peripheral nerves in diabetic neuropathy: update 2006. Acta Neurochir Suppl. 2007;100:149-51. doi: 10.1007/978-3-211-72958-8_32.

Reference Type BACKGROUND
PMID: 17985566 (View on PubMed)

Nickerson DS. Low recurrence rate of diabetic foot ulcer after nerve decompression. J Am Podiatr Med Assoc. 2010 Mar-Apr;100(2):111-5. doi: 10.7547/1000111.

Reference Type BACKGROUND
PMID: 20237362 (View on PubMed)

Dellon AL, Muse VL, Nickerson DS, Akre T, Anderson SR, Barrett SL, Biddinger KR, Bregman PJ, Bullard BP, Dauphinee DM, DeJesus JM, DeJesus RA, Ducic I, Dunkerly J, Galina MR, Hung V, Ichtertz DR, Kutka MF, Jacoby RP, Johnson JB, Mader DW, Maloney CT Jr, Mancuso PJ, Martin RC, Martin RF, McDowel BA, Rizzo VJ, Rose M, Rosson GD, Shafiroff BB, Steck JK, Stolarski RG, Swier P, Wellens-Bruschayt TA, Wilke B, Williams EH, Wood MA, Wood WA, Younes MP, Yuksel F. Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy. J Reconstr Microsurg. 2012 May;28(4):241-6. doi: 10.1055/s-0032-1306372. Epub 2012 Mar 12.

Reference Type BACKGROUND
PMID: 22411624 (View on PubMed)

Dellon AL. A cause for optimism in diabetic neuropathy. Ann Plast Surg. 1988 Feb;20(2):103-5. doi: 10.1097/00000637-198802000-00001. No abstract available.

Reference Type BACKGROUND
PMID: 3355053 (View on PubMed)

Dellon AL. Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg. 1992 Apr;89(4):689-97; discussion 698-9.

Reference Type BACKGROUND
PMID: 1546082 (View on PubMed)

Rankin TM, Miller JD, Gruessner AC, Nickerson DS. Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration. J Diabetes Sci Technol. 2015 Jul;9(4):873-80. doi: 10.1177/1932296815584796. Epub 2015 Jun 8.

Reference Type BACKGROUND
PMID: 26055081 (View on PubMed)

Other Identifiers

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Nerve DURA

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

WIRB 20122035

Identifier Type: -

Identifier Source: org_study_id

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