Dellon-style triple decompression nerve surgery In 1980, I saw my first patient with ankle tube syndrome. The patient’s name was Jacob, then 73 years old, and his physician initially attributed the numbness and burning sensation in his foot to a circulation problem. Jacob told me, “Dr. Dalen, I have been retired from government service for many years and have always lived an active and healthy life. Now that I’m older, I remember my parents needing blankets over their legs when they were older, and they told me that their feet felt cold, that they often couldn’t sleep at night, and that they had poor balance. To make matters worse, I’ve had this condition for many years as well. I had thought that advanced medications might help ease my pain, but the vascular surgeon said that my circulatory system was fine for someone my age, and you might notice that I had nerve compression in my feet that was causing these symptoms. I was interested in the Johns. Melville William, chief of vascular surgery at Johns Hopkins Hospital. Dr. William said I had ankle tube syndrome, and he said you might be able to cure me.” ”Yes, Jacob, I’ll do what I can. But you have a rare disease, and in fact, I’ve never performed anything like it before, so I’ll have to look it up, do some more research on ankle tube syndrome, and come back in a few weeks and we’ll work out a plan for you together.” I replied. When Jacob had his follow-up appointment, I said, “When a patient presents with symptoms related to carpal tunnel syndrome, if there is indeed nerve compression, there is often an area where the patient feels a tingling sensation running to the fingertips when the surgeon percusses. This phenomenon was named Tinel’s sign by a French doctor. A German physician named Hoffmann also described this condition. They both found this sign in World War I casualties and reported it in 1918. So now let me see what happens when you tap the tibial nerve in the area of the tarsal canal of your ankle.” ”Dr. Dalen, when you tap there, there is indeed a sensation that travels to the bottom of the foot and runs to my toes.” Jacob told me as I tapped on its ankle. ”Jacob, that’s good news. I’ve been working on this problem. In the carpal tunnel area of the hand, the median nerve always travels in a neural tube, so it will only be compressed in that area. However, the surgical site of the ankle canal syndrome does not coincide with the surgical site of the carpal tunnel syndrome. In fact, the location of the ankle canal in the foot corresponds to the area of the wrist at the end of the forearm. Now that I have identified the areas of nerve compression that innervate the foot and toes and the muscles of the foot, there are actually four separate nerve canals that need to be released. My proposed surgical plan is to combine two of these canals into one, and I believe this will alleviate the foot symptoms that the nerve compression is causing you.” The surgery I performed on Jacob for ankle tube syndrome initiated my interest in long-term research into lower extremity neuropathy. The four-tube ankle canal decompression method that I created has now become the standard procedure for managing this lesion. The ankle canal syndrome is becoming better known as a new branch of my research. The key to alleviating the foot and toe symptoms caused by the tibial nerve is to decompress all four canals. Regarding the treatment of the other major nerves in the leg, I have some important personal experiences. First, a compressed nerve in the knee does not simply open a fibrous tissue attached to the surface of the muscle; there are fibrous bundles attached to the deeper part of the muscle, which in turn is attached to the nerve. This nerve in the knee is called the common peroneal nerve because it gives off a branch that reaches the skin of the lower calf, the superficial peroneal nerve. in 1990, I reported on the site of deep peroneal nerve compression in the dorsum of the foot, which, like the knee, is a common site of nerve compression in patients with neuropathy. Recently, superficial peroneal nerve compression has gained attention and this uncommon site of nerve compression should be considered during the leg examination. ”Dr. Dalen, you cured my hand, can you cure my leg? ” In the past I would say, “You have nerve compression in your hand, but you have a neuropathy in your leg, and the surgeon can’t operate on the neuropathy.” But now I can say, “Let me examine your leg, and if I find evidence of nerve compression, you can perform a nerve decompression just like you would with a hand surgery. When a nerve is stuck in the leg, it can produce the same or similar symptoms as neuropathy. If you have symptoms in all 3 common areas of nerve entrapment in your leg, such as the lateral knee, dorsalis pedis and deep ankle, then the Dalen triple nerve decompression procedure will give you a great opportunity to treat your leg.” ”Dr. Dalen, this is great news, there is hope for me. However, I still have concerns… I am a diabetic, can my neuropathy be cured?” I replied, “Yes, that is a concern. The metabolic problems caused by diabetes do affect the normal function of the nerves, but I have found that this is for nerves that are not compressed. That means that when the nerve is decompressed, your symptoms will be relieved even if the nerve still has the metabolic disorder caused by diabetes. That’s because for most people, these symptoms are caused by the nerve compression.” I like to call it “quadriplegic” for those who have had quadriplegic decompression to relieve their nerve compression symptoms.