Midfoot OA doesn’t always mean fusion.
For patients with focal dorsal midfoot arthritis, a properly executed deep peroneal neurectomy can offer dramatic pain relief—without compromising joint motion or requiring a long recovery.
Pre-op block is essential. If the block works, the neurectomy usually does too.
I modify the technique slightly:
- Bury the proximal stump into the EDL or anterior tibialis muscle
- Use 6-0 Prolene under physiological tension
- Only after confirming the pain is DPN-mediated with a diagnostic block
80%+ satisfaction in recent studies (Iturregui et al., 2023)
Originally described in 2012 by my colleague Dr. Doug Blacklidge here in Indianapolis
For the right patient, this can delay or eliminate the need for midfoot fusion.
Foot & ankle surgeons—are you offering this?
Let’s discuss cases, failures, and surgical pearls.
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