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.
Similar content being viewed by others
References
Blacklidge DK, Masadeh SB, Lyons MC 2nd, Miller JM. A preliminary review of the use of deep peroneal neurectomy for the treatment of painful midtarsal and tarsometatarsal arthritis. J Foot Ankle Surg : Off Publ Am Coll Foot Ankle Surg. 2012;51(4):464–7.
Shi GG, Williams MA, Whalen JL, Wilke BK, Kraus JC. An anatomic and clinical study of the innervation of the dorsal midfoot capsule. Foot Ankle Int. 2019. https://doi.org/10.1177/1071100719858143.
Walter WR, Burke CJ, Adler RS. Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review. Skelet Radiol. 2017;46(6):795–803.
Liu SS. Evidence basis for ultrasound-guided block characteristics onset, quality, and duration. Reg Anesth Pain Med. 2016;41(2):205–20.
De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, et al. Normal anatomy and compression areas of nerves of the foot and ankle: US and MR imaging with anatomic correlation. Radiographics. 2015;35(5):1469–82.
Lawrence SJ, Botte MJ. The deep peroneal nerve in the foot and ankle: an anatomic study. Foot Ankle Int. 1995;16(11):724–8.
Yablon CM, Hammer MR, Morag Y, Brandon CJ, Fessell DP, Jacobson JA. US of the peripheral nerves of the lower extremity: a landmark approach. Radiographics. 2016;36(2):464–78.
Nwawka OK, Miller TT. Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. 2016;207(3):507–16.
Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, et al. Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis. J Clin Anesth. 2011;23(2):90–6.
Walker KJ, McGrattan K, Aas-Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database Syst. 2009(4):Cd006459.
Antonakakis JG, Scalzo DC, Jorgenson AS, Figg KK, Ting P, Zuo Z, et al. Ultrasound does not improve the success rate of a deep peroneal nerve block at the ankle. Reg Anesth Pain Med. 2010;35(2):217–21.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The second author has received a research grant from Depuy Synthes.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Johnston, S., Kraus, J., Tutton, S. et al. Ultrasound-guided diagnostic deep peroneal nerve blocks prior to potential neurectomy: a retrospective review. Skeletal Radiol 49, 1313–1321 (2020). https://doi.org/10.1007/s00256-020-03443-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-020-03443-7