Overview
Peripheral neuropathy is damage to the nerves outside the brain and spinal cord. It often starts in the feet and can cause burning, tingling, numbness, stabbing pain or sensitivity to touch. Diabetes is a common cause, along with chemotherapy, nerve injury and other conditions.
The tibial nerve runs down the inside of the lower leg, behind the ankle and into the sole of the foot. Tibial nerve stimulation places a small lead next to this nerve near the ankle. Mild electrical pulses change how pain signals from the foot reach the brain, with the goal of reducing pain and helping you stand, walk and sleep more comfortably.
At Garden State Medical Center, Dr. Dharam Mann performs tibial nerve stimulation and has done about 10 of these procedures. Dr. Mann completed fellowships in pain management, cardiac anesthesia and critical care at Massachusetts General Hospital/Harvard.
How it works
Using ultrasound or X-ray guidance, a thin lead is placed under the skin next to the tibial nerve above the ankle. It is connected to a small stimulator. You and your care team adjust the settings to find what works best for your pain.
Stimulation does not repair damaged nerves. It aims to lower the pain signals so you can do more.
Who it may be for
- Painful peripheral neuropathy in the feet, including diabetic neuropathy
- Foot pain in the area served by the tibial nerve, such as the sole and heel
- Pain that has not improved enough with medicines, physical therapy or other treatments
- People who want to avoid or reduce pain medicines with side effects
Your exam, history and test results decide whether this treatment is right for you.
What to expect
- Evaluation: we review your symptoms, past treatments and any nerve testing, and examine your feet and legs.
- Trial: in most cases a temporary trial comes first, so you can see how stimulation affects your pain in daily life before deciding on a longer-term system.
- Placement: if the trial helps, the lead is placed through a small incision near the ankle, usually with local anesthetic and light sedation. Most people go home the same day.
- Follow-up: we check the site and adjust settings at follow-up visits.
Recovery
Most people return to light activity within a few days. You may be asked to keep the site clean and dry and to limit strenuous activity for a short time. Your instructions may differ.
Risks and side effects
Every procedure has risks. Your physician will review them with you, including:
- Soreness, bruising or bleeding at the site
- Infection
- Lead movement, which may need an adjustment or a repeat procedure
- Uncomfortable or unhelpful stimulation, which can usually be adjusted
- Skin irritation from the external device
Insurance and cost
Coverage varies by plan, and prior authorization is often required. We verify benefits before scheduling. See accepted insurance.
Frequently asked questions
Will it cure my neuropathy?
No. Stimulation does not repair nerves. It aims to reduce pain. Keeping blood sugar controlled and caring for your feet are still important.
Does it help numbness?
It is used mainly for pain. Numbness may not change.
What does the stimulation feel like?
Depending on the settings, some people feel a mild tingling and others feel little or nothing.
Why is there a trial?
A trial lets you see whether stimulation helps before you commit to a longer-term system. If it does not help enough, nothing more is placed.
Who performs this at GSMC?
Dr. Dharam Mann. Ask our front desk which of his offices is most convenient for you: Toms River, Manahawkin, Whiting, Freehold or West Long Branch.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.