"This is Dr. Silvester at the Next Step Foot and Ankle Clinic, and I’m going to talk to you a little bit today about something that, for our neuropathy patients, has been a real game changer. It’s really given us another powerful tool in being able to eliminate or significantly decrease the symptoms of painful peripheral neuropathy. There’s also significant evidence that this procedure, this treatment that we do, actually helps the nerves regrow - helps the nerves to heal and become better. It’s a matter of circulation in the nerve, it’s also a matter of opening the gates that - how a nerve functions is that there are gates that allow electrical currents to pass down the nerve, and the nerve uses a lot of energy to keep those gates either open or closed, depending on what it’s trying to do.
The anatomy of a nerve is such that if you took a nerve out of this young lady’s back and down to her foot. If you spread that nerve out and magnified it at maybe 1000 times, the relative proportions of the nerve would be like a string the length of a football field.
A nerve uses more energy than any cell in the body, so the nerve, being that long and that skinny, the nerve’s ability to heal itself and deliver energy to all those little gates all along that nerve is somewhat hampered. This treatment tends to restore that and helps the nerve heal. It’s a very simple procedure, and I’m going to show you - this is the machine, it’s called the Neurogenx 4000 Pro. It has an electrical current that goes into the nerve and helps fire the nerve repeatedly over a period of time. Our treatments last about 30-45 minutes, depending on the severity of the patient’s symptoms. We do this with an integrated nerve block.
I’m going to show you where the nerves come down into your leg. There’s one right here, and this is called the common peroneal nerve. We’re going to put one patch there. There’s a nerve right back here, and this is the tibial nerve, and that comes down right there, and we’ll put a patch there. All the nerves that innervate the bottom of the foot come through here, and this is called the tarsal tunnel and the plantar nerves. Then on the top of the foot there’s also a deep peroneal nerve and there are also branches of the superficial peroneal nerve that are up here. Depending on where the symptoms are the worst, we kind of move the pads to try and treat the nerves that we’re involved with. If you don’t have very many symptoms on the deep peroneal nerve, we do it up here at the superficial peroneal nerve.
The first pad goes over the common fibular nerve, the next one goes back here where the tibial nerve comes down into the leg and it’s kind of deep right there. Most of the time we’ll treat the superficial peroneal nerve. Then, on the inside of the foot, the area of the tarsal tunnel. Now that’s all set up for nerve treatment, and all we do is turn the machine on, and we just bring up the intensity until the patient feels it. It shouldn’t be uncomfortable, but you should be able to feel it when it’s working. It’s a fairly substantial current. The next thing that we do with this is either during or after the procedure, we give local anesthetic blocks into those nerves that are most badly affected by nerve disease. We determine that with our clinical examination. Those injections consist of just a long-acting local anesthetic and so the patient leaves, they may be numb for a while or they may not feel any numbness. What happens is, the signal therapy followed with the local anesthetic therapy causes the nerve to be able to re-establish itself as far as the surrounding environment with nutritional support, vasodilation and really helps the nerves heal themselves. This has been, in about 80% of our patients who undergo this therapy, they have significant relief of their peripheral neuropathy. It’s not a one time thing. We have to do it 13 times, and sometimes we extend it beyond that. 13 treatments in general, but sometimes we extend it beyond that. That’s electrical nerve stimulation therapy with local anesthetic block. I don’t think my young assistant here wants me to give her the shots right now, so we’ll probably won’t do that. Thanks for listening!"