Title : Deep peroneal neurectomy for midfoot osteoarthritis
Abstract:
Midfoot osteoarthritis (OA), affecting the tarsometatarsal and navicular cuneiform joints, is a common cause of chronic foot pain in adults over 50. Etiologies include primary degenerative joint disease, post-traumatic arthritis, inflammatory conditions, neuropathy, and altered biomechanics. Conservative treatments such as NSAIDs, custom orthotics, physical therapy, corticosteroid injections, and immobilization are typically first-line but may fail to provide adequate relief. Arthrodesis is the standard surgical intervention for refractory midfoot OA but is associated with complications including non-union, hardware issues, nerve injury, adjacent joint arthritis, infection, and painful neuromas. Recovery from arthrodesis can be prolonged, often requiring 3 to 6 months. This presentation evaluates Deep Peroneal Nerve (DPN) neurectomy as a less invasive alternative. The DPN provides sensory innervation to the dorsal midfoot capsule and motor innervation to select foot muscles. The procedure involves resecting a segment of the DPN through a small incision near the ankle to interrupt pain signals while preserving motor function. Preoperative diagnostic nerve blocks help confirm the nerve’s involvement in pain. A review of three studies involving 84 patients (102 feet) showed moderate to high satisfaction rates (50-75%) and functional improvement, with some patients needing additional procedures. Recovery after DPN neurectomy is shorter, typically 2-3 months, compared to arthrodesis. Although promising, current evidence is limited by small sample sizes and short follow-up periods. Further research is needed to establish long-term safety and efficacy. DPN neurectomy may offer a valuable treatment option for midfoot OA, especially for patients with comorbidities or those unable to comply with arthrodesis protocols, with arthrodesis remaining a salvage option if needed.
