Dorsal Foot Pain Due to Compression of the Deep Peroneal Nerve by Exostosis of the Metatarsocuneiform Joint

Abstract

Podiatric physicians often encounter patients with dorsal foot pain related to either an exostosis or a ganglion arising at the junction of the first metatarsal and the cuneiform. Removal of the exostosis or ganglion is routine but may not relieve the pain. Exostosis surgery can result in worsening of pain owing to injury of the deep peroneal nerve. In this retrospective series, ten patients with dorsal foot pain-related exostosis or ganglion underwent measurement of the cutaneous pressure threshold of the skin of the dorsal first web space to determine whether compression of the deep peroneal nerve was related to their symptoms. The Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) was used for this measurement bilaterally, and the results were compared with age-related normative data. Ninety percent of the patients had abnormal sensibility in the first dorsal web space. During surgery, each patient was noted to have a site of compression of the deep peroneal nerve by the extensor hallucis brevis tendon at the metatarsocuneiform exostosis. Patients with compression of the deep peroneal nerve had pain relief in the immediate postoperative period and have remained pain-free for a mean of 14 months (range, 1-22 months). Neurosensory testing can identify pain related to the deep peroneal nerve in patients with a dorsal exostosis or ganglion in this region.