A Driven Surgeon Moves in on the Diabetic Foot
Lee Dellon gets his intellectual kicks from pioneering new techniques.

Hopkins Medical News
Winter 2003

Lee Dellon is back in the news. This time, it's for an unusual procedure he's developed to treat the most common complication of advanced diabetes-the agonizing tingling and numbness of the feet.

Dellon, a 1970 graduate of the School of Medicine. has always been what you might call, well, driven. A plastic surgeon who maintains two practices on opposite sides of the country-one in Baltimore, one in Tucson-he's written three books and some 300 articles on everything from cleft-palate surgery to reconstruction of the fingertip. He also gained wide recognition for pain-relieving peripheral nerve surgeries-a specialty that blends neuro and plastic surgery. "I like developing techniques that are unique," Dellon says. "I enjoy that intellectual thrill. It's the spirit of a Hopkins education."

For such accomplishments, plus the fact that since 1978 he's helped train Hopkins plastic surgery residents, Dellon received a singular nod from the School of Medicine. Johns Hopkins made him a full professor even though he's always practiced outside of Hopkins Hospital.

Dellon's interest in restoring function to damaged nerves began back in his third year of medical school. About 15 years ago he began focusing on the diabetic foot problem. Caused by nerve compression, the condition feels like rubber bands wound around the toes, according to some patients. Many with the "neuropathy" can't sense when a bath is too hot or even feel the pain when they unwittingly step on a sharp object. The ulcerations, even huge holes, that result on the soles of their feet often end in amputation.

The foot complication, Dellon knew, occurs when diabetes causes nerves to swell, decreasing the blood flow in tight anatomic areas. What he wasn't sure of at first was the exact nerves involved. Finally, he examined enough cases to figure out that the main compressions were at the outside of the knee, the top of the foot and the inside of the ankle. If he used a technique similar to carpal tunnel surgery, Dellon reasoned that he should be able to open the small canals in which the nerves travel and restore the blood flow.

He tested his hypothesis on diabetic rats and monkeys, dividing the ligament across the tarsal tunnel nerves in their feet to open the tight area. When the procedure improved nerve-function and restored sensation, Dellon moved on to humans. Today he has operated on some 400 patients for the painful foot condition, and 80 percent of them no longer suffer the distress and numbness. People from all over the nation, in fact, now flock to Dellon's Institute for Peripheral Nerve Surgery for the operation or make an appointment with one of 98 other surgeons around the world he's trained in the technique.

"The surgery doesn't cure anyone's metabolic neuropathy," Dellon makes clear. But it does relieve their symptoms. No one who's had it has developed a foot infection or ulcer or had a foot amputation. That's a pretty big step forward."