Hello, my name is Jose Tarraghi and the title of our study is Durability and Safety of Deep Peroneal Nerve Neurectomy for Midfoot Arthritis at Midterm Follow-Up, and this study was performed at Mayo Clinic, Florida. We have no disclosures. The purpose of our study was to evaluate the midterm patient satisfaction rate and pain relief in patients diagnosed with symptomatic midfoot osteoarthritis who underwent deep peroneal nerve neurectomy. This was a retrospective, IRB-approved, questionnaire-based study, and we evaluated 49 patients, including 56 feet, who underwent deep peroneal nerve neurectomy at our institution between September 2017 and February 2021. Conditions for surgery included dorsal midfoot pain secondary to osteoarthritis, lack of midfoot collapse on radiographic evaluation, an intact plantar protective sensation, inadequate pain relief with conservative management for at least six months, and a preoperative diagnostic deep peroneal nerve block resulting in transient pain relief of 75% or more. The average follow-up time was 35 months. There were 39 women and 10 men, 42 unilateral and 7 bilateral procedures performed, and the average age at the time of surgery was 68 years. A telephone questionnaire was administered and patient responses were recorded. Complications were identified in the patient medical records. This is a figure demonstrating the deep peroneal nerve neurectomy procedure. A linear longitudinal incision is made along the anterior aspect of the ankle, four centimeters proximal to the ankle joint. Dissection is carried down to the subcutaneous layer and the superficial peroneal nerve is identified and retracted. A linear incision is made through the anterior fascia over the extensor hallucis longus tendon and the tendon is retracted. The deep neurovascular bundle is identified. The deep peroneal nerve is isolated and a two centimeter segment of the deep peroneal nerve is excised. The wound is then irrigated and closed in layers. The patient's satisfaction with the result of deep peroneal nerve neurectomy in relieving their dorsal midfoot pain was 81%. 85% would repeat the surgery under the same circumstances. 84% would recommend the surgery to a friend. 10% reported they wished they had undergone arthrodesis. 92% reported pain relief in the first six months after surgery and 56% reported current activity limitations due to dorsal midfoot pain. Six feet underwent re-operation at an average post-operative time of 21 months. Complications included one deep wound infection, one deep peroneal nerve neuroma, and four patients with inadequate pain relief of which one underwent deep peroneal nerve revision, one underwent midfoot exostosis excision, and two underwent conversion to arthrodesis. Theoretic complications of neuroarthropathy, midfoot collapse, and development of lesser toe deformities were not observed. So in conclusion, for the management of chronic dorsal midfoot pain secondary to osteoarthritis, deep peroneal nerve neurectomy is a safe and effective surgical option. And at midterm follow-up, patients who underwent dorsal midfoot denervation reported acceptable satisfaction rates similar to those reported for arthrodesis which is around 90% with associated improved functional outcomes, earlier post-operative mobilization and weight-bearing, and few complications. Thank you for your time and attention.

Jose Tarraghi

Mayo Clinic

patient satisfaction

pain relief

midfoot osteoarthritis