Deep peroneal nerve neurectomy for midfoot osteoarthritis: A systematic review

Midfoot osteoarthritis affects approximately 12% of adults over 50 years and is a common cause of chronic foot pain and disability. When conservative management fails, midfoot arthrodesis remains the standard surgical treatment but carries significant morbidity, including nonunion rates of 3-10% and prolonged non-weightbearing. Deep peroneal nerve (DPN) neurectomy has emerged as a motion-preserving alternative; however, clinical evidence has not been systematically evaluated.

A systematic review following PRISMA 2020 guidelines was conducted (PROSPERO: CRD420251266344). MEDLINE, Cochrane CENTRAL, and Web of Science were searched from inception to October 2025. Quality was assessed using the ROBINS-I tool. Data were synthesised narratively due to heterogeneity in outcome reporting.

Four retrospective case series (Level IV evidence) comprising 88 patients (106 feet) met inclusion criteria. Mean age was 66.3 years; 80% were female. Follow-up ranged from 4 weeks to 51 months. Patient satisfaction was approximately 75% across studies, though variably defined and best regarded as an illustrative estimate.The pooled surgical complication rate was 5.7% (6/106 feet), comprising predominantly minor wound complications. Reoperations, including revision neurectomy, exostosis excision, and conversion to arthrodesis, were required in 7.5% of feet (8/106). Conversion to midfoot arthrodesis occurred in 4.7% of feet (5/106). All four studies were assessed as having serious risk of bias using ROBINS-I.

DPN neurectomy may provide clinically meaningful pain relief with low complication rates in selected patients with midfoot osteoarthritis, offering faster recovery than arthrodesis. Current evidence is limited to small retrospective case series; prospective comparative studies are needed.