Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease

Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm3/s vs. 2.50 ± 0.45 cm3/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain.