Published Saturday, July 30, 2005
Procedure Can Help Curb Neuropathy Pain
By Robin W Adams
LAKELAND -- Pain and numbness became a daily part of Mary Hunt's life after she developed diabetic neuropathy -- nerve damage caused by diabetes.
“I would wake up at night because my legs would burn," she said. "The stress it puts you under with the pain is unbelievable."
Yet, the Winter Haven woman could step on a sharp object and not feel anything.
That loss of feeling can lead to serious problems, such as being unable to feel the pedals when driving or an increasing risk of ulcers and infection.
About half of Americans diagnosed with diabetes suffer from some form of nerve damage, according to the American Diabetes Association.
While other conditions can cause neuropathy, diabetes is the most common culprit.
Hunt's neuropathy hasn't gone away, but she said outpatient surgeries this spring eliminated the accompanying pain, tingling and numbness.
What proved effective for Hunt was the Dellon procedure, which involves cutting through connective tissues in the leg and ankle to relieve pressure on the nerve.
Dr. A. Lee Dellon, a plastic surgeon from Johns Hopkins University, designed the procedure to give patients with nerve compression in their legs the relief possible in the wrists from carpal-tunnel surgery.
Though Dellon started developing the procedure more than 15 years ago, it remains relatively unknown. Only a
handful of doctors each year train to perform the procedure.
Two Polk County podiatric surgeons began offering the procedure locally in December.
Writing in the October Foot & Ankle International Journal, Dellon said the procedure can "offer a new source of optimism" for patients with neuropathy.
The tarsal tunnel in the ankle is equivalent to the carpal tunnel in the wrist, with the same narrowness that makes it possible for nerves swollen by diabetes to become compressed or pinched, said Dr. Michael Gallina, a local podiatric surgeon.
Dellon, who practices in Baltimore and Tucson, trains other doctors in the procedure. Gallina and Dr. Tatiana A.
Wellens-Bruschayt, one of his partners at Central Florida Foot and Ankle Center, LLC took the five-day training in
They have performed the procedure on 27 patients since then.
"We were kind of skeptical about it at first," Wellens-Bruschayt said. "We were taught for years that diabetic neuropathy was irreversible."
After learning more about the procedure, however, she said they realized that, although the procedure doesn't offer a cure for neuropathy, it can relieve or eliminate symptoms.
"People wake up in the recovery room, and they can feel their feet," Wellens-Bruschayt said. "They don't have the pain."
For the Dellon procedure, doctors make a 3-inch cut in the leg, a 4-inch cut on the inside of the ankle and a 1 -inch cut over the top of the foot.
Surgery opens the tight area through which the nerve passes, giving it more room and allowing for better blood flow, Gallina said.
Recuperation is relatively easy, the local surgeons said.
Patients can walk within a day of surgery, though they must wear a boot for a couple of weeks to let the scars heal.
Wound healing can be slow with diabetics, however. Some patients may need physical therapy before they can resume normal walking if they had been walking on the sides of their feet.
The procedure can be done successfully if there isn't too much damage on the inside of the nerve, Gallina said. Later on in the disease, however, the damage can be irreversible.
Gallina and Wellens-Bruschayt, who maintain offices in Winter Haven and Lakeland, said they use a sensory device designed by Dellon and an engineer for early diagnosis of nerve dysfunction.
They are starting to mail information about the test and surgery to local doctors. Gallina also will speak on the procedure at the National Podiatric Medical Association meeting in Orlando in early August.
"Not only do we relieve pain and ulceration, we reduce amputations," Gallina said. "If you keep a patient walking, you increase their longevity and health."
I am a 63 year old white female. I have been bothered with diabetic neuropathy for about 8 years. It had gotten so bad, it was totally consuming me. The pain and tingling were there 24 hours a day, 7 days a week. I have been taking Neurontin (1800 mg. Daily) for about 3 years and it did help a little, but the pain and the tingling numbness were so bad at night that I had trouble sleeping. I read an article in the local newspaper about the Dellon Procedure. I understood it was not a cure for neuropathy, but might give me some relief. I spoke with my primary care physician and he recommended that I try it. I made an appointment with Dr. Michael Gallina, who performs the procedure. He gave me an exam and said the chances of it helping me were only about 35%. I decided to have the procedure. I had surgery on my right foot on November 4, 2005 and followed with the left foot on December 2, 2005.
I am so glad that I had it done, because the pain that I experienced from my feet and into my leg is no longer there. I still have a small amount of the numbness and tingling in my toes, but it is so much better. I would say that I have at least 75% of the feeling back in my feet and none of the sharp shooting pain from my toes into my legs. The Dellon Procedure has certainly worked for me and I would recommend it to anyone who has diabetic neuropathy.
-- Martha H.
I am a production painter for General Motors. I suffered with severe, almost crippling foot and heel pain for over two years. I began treatment with Dr. Gallina at the Central Florida Foot & Ankle Center, LLC in August. 1 received a diagnosis for treatment without surgery. Custom prosthetics were ordered to correct the constant, chronic pain. While waiting for the insoles, medication was prescribed to relieve my pain. I was extremely skeptical, but the insoles have made an enormous difference. My foot and heel pain has been reduced considerably. My feet feel 90% better already. The staff has catered to my every need. Dr. Gallina is always available, if I need to consult with him about my foot pain. I refer all my family and friends to Dr. Gallina and the Central Florida Foot & Ankle Center, LLC. Foot and heel pain relief has made a difference in my everyday life.
-- Damon B.
Last week was really a lot of fun for the old Chef. Monday and Tuesday were superb. Then another different ball game. Wednesday had a doctor appointment with my family physician and he told me I needed to immediately have a stress test since my EKG came back not looking good. Try as I may, I was unable to convince him that nothing was wrong with my heart. However, my talk was in vain. Thursday morning I go back for a treadmill stress test. As I suspected, I passed with flying colors, which gave the doctor liberty to give medical clearance for surgery I had scheduled for Friday. Thursday afternoon it was a trip to the Lakeland Regional Cancer Center for a scheduled biopsy (Won't get the results of that until today.) Friday I had surgery on my left foot. And, this is the reason for my column today. I have diabetic neuropathy which until recently I had been told by neurologists that it was incurable, inoperable and only got worse. Well, when I moved to our fair city, I had been here a very short time when my daughter brought me a newspaper article about my problem. Seems that Dr. Michael Gallina, of the Central Florida Foot and Ankle Center, LLC (offices in Lakeland, Winter Haven and Davenport) was performing surgery that belied all I had previously been told, Dr A Lee Dellon, a plastic surgeon with Johns Hopkins University developed a procedure which gives relief from the constant pain, The surgery, similar to carpal tunnel syndrome, is done in a local day surgery center There are a total of three incisions which allow the surgeon to jockey the nerves around as it were, and give them more room and allow a better blood flow. You walk in, have your surgery, you walk out! Sure there are a couple of down sides, if you want to call it that. Number 1 is that you can't drive yourself home, cause you've been put to sleep for the operation. Number 2 is that you have to wear a surgical boot (not a Gucci design) for a couple of weeks That's the extent of the down sides Honestly, prior to having this done, I had no feeling below my knees I could get in a hot tub and not know if the water was hot, cold, wet or dry. Before I left the surgery center I had started to get feeling back in the foot. You can get your boots, I'm going to have the other one done as soon as Dr. Gallina says I can (probably four to six weeks.) For anyone who suffers from peripheral neuropathy, do yourself a huge favor and make an appointment to see Dr. Gallina or his partner Dr. Tatiana Wellens-Brusehayt. If you, like I, have been told there is no hope or cure, don't you believe it. Now there is!! !
Ready for some new stough? Here goes:
-- Chef Don
On October 6th Dr. Wellens and Dr. Gallina performed a Dellon procedure on my right leg. Prior to the surgery I was losing feeling in my leg and foot. I also had constant shooting pain in my foot and toes and constant pain on the outside of my knee. These problems only go worse at night. I would have to get out of bed several times a night to walk around. The surgery has helped a lot. I do not have the shooting pains in the front part of my foot or toes. My lower leg doesn't feel like someone is pouring water on it and it has helped with the knee pain. I can lay in bed and finally get some sleep. I still have loss of feeling in my toes, but it doesn't keep me awake at night. I need this procedure done on my left leg also. Based on the results so far which is less than 1 month I will gladly have Dr. Wellens and Dr. Gallina do this procedure. I feel that as more time goes by this will only improve more.
-- Mike V.
I want to thank you so much for being the kind of doctor most people only wish they could have and I was lucky to have. Only because of your correct diagnosis do I have both feet still. I wish more doctors would take the time as you did and make the diagnosis right as you did. I appreciate everything you have done for me. Again thank you very muc
-- Pete C.