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Stable Long-term PROMIS Outcomes After Deep Peroneal Nerve Neurectomy for Midfoot Arthritis: A Longitudinal Study
Seif El Masry1, Cesar A Ramirez1, Gabrielle M Meli1
1Mayo Clinic in Florida, Department of Orthopedic Surgery, Jacksonville, FL, USA.
Foot & Ankle Orthopaedics
|July 23, 2026
Summary
Deep peroneal nerve (DPN) neurectomy offers stable pain relief for midfoot arthritis long-term, though not all patients experience significant functional improvement. This surgery provides durable symptom stability for carefully selected individuals.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Neurosurgery
Background:
- Midfoot arthritis causes significant dorsal pain and limits function.
- Deep peroneal nerve (DPN) neurectomy is a minimally invasive surgical option for pain relief via selective denervation.
- Long-term durability of DPN neurectomy for midfoot arthritis is not well-established.
Purpose of the Study:
- To evaluate long-term changes in patient-reported physical function and pain interference after DPN neurectomy.
- To assess the durability of DPN neurectomy outcomes using validated PROMIS instruments.
- To compare midterm and long-term functional and pain outcomes following DPN neurectomy.
Main Methods:
- Retrospective review of patients undergoing isolated DPN neurectomy for midfoot arthritis (2017-2021).
- Utilized PROMIS Physical Function (PF) and Pain Interference (PI) questionnaires at midterm (mean 2.9 years) and long-term (mean 6.1 years) follow-up.
- Compared PROMIS scores using paired t-tests and defined clinically meaningful improvement using MCID thresholds.
Main Results:
- 32 patients included (81.2% female, mean age 68.4 years).
- Physical Function (PF) showed a nonsignificant mean improvement (+1.3 points, P=.188).
- Pain Interference (PI) showed a statistically significant decrease (-3.4 points, P=.020), but below MCID. Clinically meaningful improvement was achieved by 21.9% for PF and 46.9% for PI.
Conclusions:
- DPN neurectomy demonstrates stable longitudinal PROMIS outcomes through extended follow-up.
- The surgery provides a statistically significant decrease in pain interference, though often below the minimal clinically important difference.
- Outcomes are heterogeneous, suggesting DPN neurectomy may offer durable symptom stability in selected patients but individual benefit is not universal.