Diabetic peripheral neuropathy (DPN) is a common complication of diabetes that causes pain, numbness, and ulcers in the lower extremities. The study compared traditional nerve decompression (ND, n=12), modified ND (n=16), and modified ND with mouse nerve growth factor (MNGF, n=14) in patients with DPN of the lower extremities. Modified ND involved selective decompression of tendon-like structures without extensive nerve dissection. All groups showed improvement in nerve function at 4 and 12 weeks (p<0.05), as measured by motor nerve conduction velocity, Toronto Score (TCSS), VAS, two-point discrimination, monofilament test, and nerve area on ultrasound. The modified ND + MNGF group had the greatest improvements with significant differences compared to traditional ND (p<0.05). The modified technique reduced surgical trauma and postoperative complications without serious adverse events. The authors recommend further validation in larger multicenter studies.