Dellon Decompression of the Tarsal Tunnel: An Effective Approach to Improving Blood Flow and Promoting Ulcer Healing in Diabetic Patients
Sofija Pejkova, MD PhD1, Sofija Tusheva, MD1, Bisera Nikolovska, MD PhD1, Savetka Paljoskovska, MD2, Stefania Azmanova Mladenovska, MD1, Blagoja Srbov, MD1, Katerina Jovanovska, MD1 and Gordana Georgieva, MD1, 1University Clinic for Plastic and Reconstructive Surgery, Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of, 2University Clinic for Cardiology,Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of
Introduction:We hypothesized that improving sympathetic nerve function through tibial nerve decompression would lead to enhanced blood flow, improved sensibility of the plantar area, and reduced ulcer healing time in patients with diabetic neuropathy.
Material and methods: We designed a prospective study including 20 patients with non-healing diabetic neuropathic ulcers, present for a mean of 17.1 (range 9 to 60) months. The onset of diabetes in this cohort was 41.8 (range 42–96). Inclusion Criteria were good glycemic control,positive Tinel sign at the tarsal tunnel and persistent foot ulcer with mean size of 10.49 cm². (range 5.4-24 cm2). Pre-operatively, sensory symptoms were evaluated with Michigan Neuropathy Screening Instrument (MNSI), and blood flow was evaluated by Doppler ultrasonography of the posterior tibial artery at ankle, while ulcer characteristics were analyzed using the DMIST scale. "Dellon Decompression" of the four medial ankle tunnels was performed. At follow-up, blood flow, MNSI, and ulcer diameter were observed.
Results: Neuropathy symptoms, as evaluated by MNSI, demonstrated a substantial decrease at 9-month follow-up from a mean of 11.85 pre-operatively to 5.15 (p<0.001). The specificity of Tinnel sign in diabetic neuropathy was confirmed by quantifying its positivity through the VAS scale, which decreased at 9 months from a mean of 9 pre-operatively to 2 (p<0.0001) Furthermore, by comparison of the peripheral nerves sensory function in the operative vs. control foot of the same patients by TPD-MRC, statistically significant differences were identified regarding the medial and lateral plantar nerves, as well as the calcaneal nerve (p<0.001). Doppler ultrasonography revealed a significant improvement in blood flow within the posterior tibial artery, increasing from 1.72 to 2.48 cm³/sec at 6-month follow-up, with a tendency for improvement from 2.48 to 5.34 cm³/sec at 9 month follow up following tibial nerve decompression (p<0.0001). At the 9-month follow-up, 55% of patients had completely healed ulcers, while in 45% there was an 83.25% reduction in ulcer size, which was in correlation with DMIST from a mean of 12 pre-operatively to 2 points at the 9-month follow-up (p<0.0001). No wound infections or new ulcer formations were observed post-operatively.
In conclusion, decompression of the sympathetic fibers within the tibial nerve at the ankle can enhance blood flow in diabetic neuropathy. Dellon Decompression of the four medial ankle tunnels also improves wound healing in the foot's plantar area and emphasizes the crucial role of enhanced blood flow and sensibility in promoting ulcer healing in diabetic patients.
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