Ultrasound-guided diagnostic deep peroneal nerve blocks prior to potential neurectomy: a retrospective review

Abstract

Objective: To describe our technical and preliminary clinical experience with ultrasound-guided diagnostic deep peroneal nerve (DPN) blocks for patients considering deep peroneal neurectomy.

Materials and methods: Retrospective analysis of ultrasound-guided diagnostic DPN blocks performed in the anterior lower leg in patients pursuing deep peroneal neurectomy for foot pain not directly attributable to the DPN. Patient age, sex, foot laterality, diagnosis, nerve block complications, location of the DPN with respect to vascular landmarks in the lower leg, pain relief from nerve block, and pain relief from neurectomy (if performed) were recorded.

Results: Twenty-six DPN blocks were performed for 25 feet, of which a majority had pain attributable to midfoot osteoarthritis (22/25). Variable DPN locations with respect to vascular landmarks in the lower leg were observed, including lateral to the anterior tibial artery (12/25), anterior to the artery (5/25), medial to the artery (3/25), lateral to the lateral paired vein (4/25), and 1-cm lateral to the artery (1/25). After DPN blocks, patients reported pain relief in 22/25 feet. Of the eleven patients who proceeded to have a deep peroneal neurectomy, ten reported improved foot pain.

Conclusion: Diagnostic deep peroneal nerve blocks for patients considering deep peroneal neurectomy for denervation therapy should be performed in the anterior lower leg where the anterior tibial vessels serve as anatomic landmarks. Those who perform DPN blocks with ultrasound guidance should be aware of variable DPN position with respect to the vascular landmarks.

Keywords: Deep peroneal nerve; Midfoot osteoarthritis; Nerve block; Neurectomy.