Durability and Safety of Deep Peroneal Nerve Neurectomy for Midfoot Arthritis at Midterm Follow Up

Category: Midfoot/Forefoot Introduction/Purpose: Midfoot osteoarthritis affects up to 12% of the adult population greater than 50 years old. Arthrodesis is the traditional surgical procedure performed when nonoperative management fails but is a technically demanding procedure that requires prolonged postoperative immobilization and is not uncommonly complicated by nonunion or deep infection. The deep peroneal nerve (DPN) plays a significant role in afferent nociceptive midfoot joint pain perception, most consistently in the second and third tarsometatarsal joints and the naviculocuneiform joint. Early outcomes following DPN neurectomy have demonstrated promising results as a safe and effective treatment that allows early mobilization and weight bearing. The purpose of our study was to evaluate the mid-term patient satisfaction and pain relief after DPN neurectomy for treatment of chronic midfoot pain due to osteoarthritis. Methods: In this retrospective IRB-approved questionnaire-based study, we evaluated 49 out of 95 patients identified (56 feet) with an average follow-up of 34.6 (range, 9 to 51) months, who underwent DPN neurectomy (Figure 1) at our institution between September 2017 and February 2021. There were 39 women and 10 men, 42 unilateral (23 right, 19 left) and 7 bilateral procedures, with an average age of 67.9 (range, 35 to 88) years at the time of surgery. A questionnaire which included questions regarding post-surgical dorsal midfoot pain relief, surgical result satisfaction, and current functional limitations was administered via telephone. Demographic information, patient responses, and complications were recorded. Results: There was an 81.2% patient satisfaction with the result of the surgery in relieving their dorsal midfoot pain. Of the 49 patients, 84.9% would repeat the surgery under the same circumstances, 84.1% would recommend the surgery to a friend, 10.2% reported they wish they had undergone arthrodesis, 8.2% reported no pain relief in the first 6 months, and 55.8% reported current activity limitations because of dorsal midfoot pain. Six feet (10.7%) underwent a second procedure with an average postoperative time of 20.5 (range, 1 to 36) months. Complications include one patient with deep wound infection, one DPN neurectomy revision and burial into bone, one DPN neuroma excision, one midfoot exostosis excision, and two conversions to arthrodesis. Theoretic complications of neuroarthropathy, midfoot collapse, and development of lesser toe deformities were not observed. Conclusion: DPN neurectomy is a safe and effective surgical option for the management of chronic dorsal midfoot pain due to midfoot osteoarthritis after failed nonoperative management. At midterm follow-up, patients who underwent dorsal midfoot denervation reported acceptable satisfaction rates, similar to those reported for arthrodesis, with associated improved functional outcomes and few complications.