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California Foot & Ankle Institute

What is Neuropathy?

Burning, tingling, numbness, pins and needles sensation, weakness and muscle cramping are all common symptoms associated with neuropathy. These symptoms can range in severity from the occasional numbness and tingling sensation, all the way to complete loss of feeling and function of the foot and/or leg.

 Slowly with exaggerated caution and obvious discomfort, a middle-aged female enters the examining room. "Doctor," she says. "I have horrible pain in both my feet, likeI am walking on broken glass." Her eyes brim with tears telegraphing the intensity of her suffering. "Now, I know this will sound crazy, but it also seems like my feet don't have much feeling, almost like I'm walking on a sponge or I am wearing very thick socks."

Scenarios like this play out in our office on a daily basis. Pain can in some cases be so excruciating that patients and their families become hopeless and desperate. At California Foot and Ankle Institute, we have a variety of advanced treatments that have provided relief for our patients.

What causes Neuropathy?

Neuropathy is caused when a nerve no longer functions normally, and there are a number of conditions that can cause or contribute to the problem, including:

Neuropathy is caused when a nerve no longer functions normally, and there are a number of conditions that can cause or contribute to the problem, including:

  • Trauma causing physical damage to the nerve
  • Chronic conditions such as diabetes
  • Repetitive stress on a nerve
  • Compression of the nerve due to abnormalities of the anatomy

Typically neuropathy is a progressive condition that could lead to more severe problems. Therefore, the key to successful treatment of neuropathy is identifying it in its early stages as it becomes much more difficult to manage when it is advanced.

 Diabetic Neuropathy

The most common form of neuropathy is a side effect of poorly controlled diabetes. Excess sugar in the blood stream enters the nerves where it is converted into sorbitol, which cannot easily exit the nerve. The body reacts by drawing excess water into the nerve eventually leading to swelling. Swollen nerves in turn become compressed as they travel into the tunnels or spaces between structures where nerves live and enter the legs and feet.

Swollen nerves become compressed trying to fit within these tunnels. When the nerve becomes compressed, the blood vessels feeding the nerves are then constricted causing loss of circulation. These factors all contribute to the painful symptoms of neuropathy. Neuropathy is the leading cause of diabetic ulcerations and infections, as well as the loss of toes and in more advanced cases, amputation.

Revolutionary Treatments for Neuropathy

Many patients come to us having been told that there is very little that can be done to improve their situation and neuropathy is something they will "just have to live with." At California Foot and Ankle Institute we have invested our time to research the best possible treatments and train in the most advanced procedures for neuropathy. And as a result, most of our patients have significant improvement in their condition.

The goal of neuropathy treatment is to increase circulation to the nerves, decrease swelling in the legs and reduce painful symptoms such as pins and needles and burning sensation. Typically the symptoms of neuropathy are treated with drugs such as Neurontin (Gabapentin), Lyrica (Pregabalin), and Cymbalta (Duloxetine). The problem is that these drugs only mask the symptoms but don’t treat the underlying cause. Many patients come to us after working with multiple doctors and spending thousands of dollars on unproven treatments only to find that their neuropathy has worsened. Our approach is based on what actually treats the problem, not just masking the pain.

To help identify the treatment solutions that may be available for you, review the chart below and choose the number that most closely describes your condition.

surgery chart2

If you identify most with number 1 or 2, MicroVascular Therapy will help you.

If you identify most with numbers 3, 4 or 5, then a combination of MicroVascular Therapy, Metanx and Moxxor plus nerve decompression surgery should be considered. In 85% of cases, a combination of these treatments can eliminate pain and restore sensation.

MicroVAS Treatment (MicroVascular Therapy)

MicroVAS Treatment reverses peripheral neuropathy and closes non-healing wounds. Non-invasive physical medicine has many applications for healing, through 4 simple methods:

DSC 3710

  • Increases Circulation which elevates tissue oxygenation thus aiding in: collagen formation; stimulates fibroblasts andosteoblasts to promote and accelerate healing of wounds and bone; rebuilds blood vessels; and perfuses the blood carrying oxygen to the capillary beds.
  • Involuntary Exercise promotes muscle building and re-alignment of muscles, tendons and ligaments. Aids in flexion and range of motion, while elevating metabolism.
  • Lymphatic Drainage is boosted 10 to 30 times which decompresses nerves, relieves swelling and inflammation and reduces pain associated with strains, sprains and arthritis.
  • Pain Management is provided by the blocking of neurological transmission of pain signals and stimulation of endorphins.

The MicroVAS System provides neurovascular therapy. It does this by using a powerful ionic waveform that goes completely through the entire limb or body to create deep layered, pulsed muscle contractions, which stimulate therapeutic angiogenesis. Not only does it increase cellular oxygen levels during treatment, but the levels are uniquely elevated after therapy, providing sustained results.

Metanx® - Nutritional Supplement

As an alternative or sometimes a complement to standard drug therapies, our doctors may recommend Metanx® (meta-nex) – a medical food that causes dilation of the microvessels around the nerves allowing oxygen and nutrients to feed the nerve. Traditional over-the-counter vitamins are synthetic forms of the nutrients found in nature. This is the case for common B-vitamins such as folic acid, vitamin B6 and vitamin B12. Each of these must be converted into their natural, active forms before they can actually be used by the body’s cells for such vital functions as DNA production, cell reproduction and homocysteine metabolism. A medical food delivers nutrients in their active, naturally occurring form for the body to use immediately, it does not require the body to break down and convert the nutrients into a form it can use.


Matanx contains specially formulated nutritional requirements needed by patients to restore the metabolic processes associated withneuropathy to:

  • Maintain blood flow in the blood vessels that carry the nutrients and oxygen to your nerves
  • Provide the required nutrients to help facilitate nerve repair including production of the myelin sheath, a substance that insulates and protects nerve fibers

As a result, patients have seen improvements in TOTAL symptoms including:

  • Numbness
  • Tingling
  • Aching Pain
  • Burning Pain
  • Shooting Pain
  • Extreme Sensitivity to Light Touch

Metanx requires a prescription and is administered only to patients under the care of a physician. The average time for most patients to feel a difference with Metanx is about three weeks. Individual results may vary. Do not start taking Metanx without first talking to your healthcare provider.

MOXXOR® -- Nutritional Supplement

We have found that adding Moxxor® to our patients' peripheral neuropathy regimen has been very beneficial. Moxxor is unique in that it provides anti-inflamatory properties, Vitamin E and anti-oxidants that reduce oxidation and free radicals which are damaging to nerve tissue. The combination of these high quality ingredients help reduce cellular damage and promote healthy restoration of vital neurovascular tissues. MOXXOR® combines three powerful all-natural ingredients from the pure pristine environment of New Zealand:

  • Omega-3 extracted from the Greenlip Mussel
    • Includes a concentrate of polyunsaturated fatty acids (PUFA’s) extracted from Perna canaliculus (the New Zealand greenlip mussel). The omega-3 fatty acids found in greenlip mussels are substantially more effective than found in other omega-3 oils on the market.
  • Vitamin E from the Kiwifruit Seed
  • Antioxidant extracted from the Sauvignon Blanc grape seed husk
    • Researchers have shown that antioxidants effectively combat free-radicals. The antioxidants found in MOXXOR are free from genetically modified material, heavy metals, arsenic, toxins, and pesticides. A standard known as ORAC (oxygen radical absorption capacity) is often used to compare the relative strength of antioxidants.

Surgical Option: Nerve Decompression

If conservative treatment for diabetic and non-diabetic peripheral neuropathy fails to achieve the results our patients are seeking, there may be a surgical option available for some patients. Two of our doctors have been trained in a procedure called nerve decompression. This is a highly specialized surgery that only 300 doctors in the United States are trained to perform.

Nerve decompression surgery has helped thousands of neuropathy patients who suffered from moderate to severe and debilitating neuropathy pain that did not respond to other treatments. Our techniques are based off of the approach of Dr. Lee Dellon, a famous surgeon at Johns Hopkins Medical Center, who decades ago developed what is today the standard surgical techniques for decompression of peripheral nerves that are damaged or diseased due to diabetes, injuries, or entrapment from abnormal anatomical structures.

During the procedure, the surgeon releases connective tissue (fascia) that surround nerves along different parts of the leg, ankle and foot. Sometimes these fascial bands can be so tight that the nerves are being strangulated. Often times after the constrictive fascial band is released during surgery, we can literally watch the blood vessel fill and begin to supply to the nerve beyond the areas of constriction where it was blocked. Nerve decompression is a surgical procedure and is performed under sedation and local anesthetic at an outpatient surgical center.

At times we are working with very small nerves which is considered microsurgery. Following the procedure, patients are encouraged to walk and resume as much of their regular activity as they can tolerate. The activity allows the newly released nerves to freely guide through the tunnels without constriction, which helps to prevent scar tissue from developing around the decompression site. Even though nerve decompression surgery is remarkably successful with a short recovery time, this procedure is still one of the best kept secrets in the medical community, perhaps because of its highly specialized nature and the advanced training required.