Midfoot Denervation: A Faster, Reliable Alternative to Fusion?

by Vince Vacketta, DPM

A new longitudinal study, Stable Long-term PROMIS Outcomes After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis, found that deep peroneal nerve (DPN) neurectomy provided durable pain relief at six-year follow-up. These results support it as a viable motion-preserving alternative to midfoot arthrodesis in carefully selected patients.

Key findings

• Nearly half of patients (47%) achieved clinically meaningful pain improvement.

• Pain relief was maintained long-term, physical function remained stable.

• Only four patients ultimately required conversion to fusion.

• Unlike arthrodesis, DPN neurectomy avoids risks of nonunion and hardware complications, offers faster recovery and preserves motion, and leaves fusion as a future option if symptoms progress.

Takeaway

DPN neurectomy offers a durable, joint-sparing option, particularly for patients with health or function challenging for arthrodesis. The study shows it can provide meaningful, long-term pain relief, allowing many patients to delay – or potentially avoid – fusion altogether. As always, patient selection remains key.