Patient Satisfaction and Pain Relief After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis: A Preliminary Short Report

Abstract

Background: The deep peroneal nerve (DPN) plays a role in afferent nociceptive dorsal midfoot joint pain perception. DPN neurectomy for treatment of symptomatic dorsal midfoot osteoarthritis allows early mobilization and weightbearing. The purpose of our study was to evaluate the patient satisfaction and pain relief after DPN neurectomy for treatment of chronic dorsal midfoot pain due to osteoarthritis. Methods: In this retrospective, IRB-approved, questionnaire-based study, we evaluated 48 patients (55 feet) with an average follow-up of 35.1 (range, 16-51) months who underwent DPN neurectomy at our institution between September 2017 and February 2021. There were 38 women and 10 men, 41 unilateral (22 right, 19 left) and 7 bilateral procedures, with an average age of 67.8 (range, 35-88) years at the time of surgery. A questionnaire that included questions regarding postsurgical dorsal midfoot pain relief, surgical result satisfaction, and current functional limitations was administered via telephone. Demographic information, patient responses, and complications were recorded. Results: Of the 48 patients, 80.8% were satisfied with the result of the surgery in relieving their dorsal midfoot pain, 84.6% would repeat the surgery under the same circumstances, 83.8% would recommend the surgery to a friend, 10.4% reported they wish they had undergone arthrodesis, 91.7% reported pain relief in the first 6 months, and 55.6% reported current activity limitations. Six feet (10.9%) underwent a second procedure with an average postoperative time of 20.5 (range, 1-36) months. Complications included 1 hematoma and deep wound infection, 1 DPN neuroma and superficial peroneal nerve entrapment, and 4 patients with inadequate pain relief. Conclusion: In this cohort, DPN neurectomy appeared to be a reasonable surgical alternative to arthrodesis for the management of chronic dorsal midfoot pain due to midfoot osteoarthritis after failed nonoperative management. Level of Evidence: Level IV, retrospective case series.

Deep Peroneal Neurectomy for Midfoot Arthritis: A Comprehensive Review, Surgical Technique, and Case Series

“…The average follow-up duration was 35.1 months (range 16 to 51 mo). 19 Thirty-three patients (68.8%) reported being satisfied or very satisfied with the surgery. In addition, 44 patients (91.7%) reported pain relief in the first 6 months postoperatively and 24 (50%) patients reported no activity limitations.…”

“…Of the studies identified, all were retrospective analyses. [16][17][18][19] Treatment of symptomatic midfoot arthritis with deep peroneal neurectomy:…”

“…Six patients required an additional procedure for their midfoot pain at an average of 20.5 months postoperatively. 19 The authors of all 4 studies concluded DPN neurectomy is a reasonable surgical alternative to arthrodesis for the management of painful midfoot OA. The overall complication rate was 7.1%, with the most common complication being cellulitis (Table 1).…”

“…14,15 There is emerging evidence that DPN neurectomy may be an effective treatment for TMTJ and NCJ arthritis. [16][17][18][19] Complications of neurectomy can include inadequate pain relief, recurrent pain, painful neuromas, advancement of arthritis, and risk of Charcot formation, but do not yet appear to be fully characterized. [16][17][18][19] The purpose of this review is to summarize all studies using deep peroneal neurectomy to treat symptomatic midfoot arthritis results and evaluate outcomes and complications.…”

“…[16][17][18][19] Complications of neurectomy can include inadequate pain relief, recurrent pain, painful neuromas, advancement of arthritis, and risk of Charcot formation, but do not yet appear to be fully characterized. [16][17][18][19] The purpose of this review is to summarize all studies using deep peroneal neurectomy to treat symptomatic midfoot arthritis results and evaluate outcomes and complications. This is followed by a brief case series intended to contribute to the limited literature that exists on patient outcomes following DPN.…”