Keywords: PROMIS, Midfoot, Joint Preserving Surgery
Introduction/Purpose: Midfoot arthritis can cause severe pain and functional limitation. Deep peroneal nerve (DPN) neurectomy has emerged as a minimally invasive, motion-sparing procedure that addresses dorsal midfoot pain through selective denervation. A recent study demonstrated high satisfaction and meaningful pain relief at two years, but durability beyond this timeframe remains unknown. To our knowledge, no other study has reported long-term outcomes of DPN neurectomy. The purpose of this study was to evaluate changes in patient-reported physical function (PF) and pain interference (PI) between midterm and long-term follow-up using validated PROMIS instruments. We hypothesized that improvements in PI would be maintained at long-term follow-up and that PF would remain stable without significant decline.
Methods: We conducted a retrospective review of patients who underwent isolated DPN neurectomy for midfoot arthritis between 2017 and 2021. Inclusion criteria required available PROMIS PF and PI scores at both midterm (≥2 and <4.5 years) and long-term (≥4.5 years) postoperative intervals. Patients who had undergone conversion to arthrodesis were excluded from the final analysis. Patient demographics, including age at surgery, sex, BMI, and laterality, were recorded. PROMIS PF and PI T-scores were collected at both follow-up intervals. Within-patient differences were analyzed using paired t-tests. Clinically meaningful improvement was defined using published minimal clinically important difference (MCID) thresholds: +5.5 for PF and –5.8 for PI. The proportion of patients achieving MCID improvement or demonstrating worsening scores was recorded.
Results: The final cohort included 32 patients (81.2% female, mean age 68.4 ± 7.3 years, mean BMI 29.6 ± 6.6). Of note, 4 patients were excluded due to conversion to arthrodesis. Surgery was right-sided in 53.1%, left-sided in 34.4%, and bilateral in 12.5%. PROMIS PF improved from 37.7 ± 6.2 to 39.0 ± 7.5 (Δ = +1.3, p = 0.188), while PROMIS PI decreased from 62.6 ± 8.8 to 59.2 ± 9.0 (Δ = –3.3, p = 0.020). Clinically meaningful improvement was achieved by 7/32 patients (21.9%) for PF and 15/32 (46.9%) for PI. Five patients experienced worsening scores, associated with notable events including one stroke, one ankle fracture ORIF, one new diagnosis of chronic pain syndrome, and two cases of severe contralateral arthritis.
Conclusion: Patients undergoing DPN neurectomy for midfoot arthritis demonstrated sustained improvements in PROMIS PI through an average of six years of follow-up, with PF remaining stable. Nearly half of patients achieved clinically meaningful reductions in pain, while only a small minority deteriorated, often due to unrelated comorbidities or contralateral disease. These findings support the long-term durability of DPN neurectomy and its role as a motion-sparing option for dorsal midfoot pain refractory to conservative management. Longitudinal PROMIS assessment highlights that pain relief can be maintained beyond midterm, underscoring the procedure’s durability in selected patients.
