Osteoarthritis is one of the most common causes of chronic foot and ankle pain. As cartilage within a joint gradually wears down, bones begin to rub against each other. This leads to inflammation, stiffness, and persistent pain that can make walking and daily activities uncomfortable. Because the foot contains numerous joints that bear weight and absorb stress, osteoarthritis can significantly impact mobility and quality of life.

In the foot, osteoarthritis most frequently affects the big toe joint (first metatarsophalangeal joint), midfoot joints, and the joints on top of the foot near the ankle. Patients often experience pain on the top of the foot, swelling around affected joints, stiffness when walking, difficulty wearing shoes, and discomfort when pushing off during walking or exercise. Symptoms tend to worsen gradually as arthritis progresses.

Non-Surgical Treatments for Osteoarthritis of the Foot and Ankle

Many patients find relief through conservative treatments designed to reduce inflammation and improve joint support. These include:

• Supportive footwear to reduce stress on joints

• Custom orthotics to improve foot mechanics and alignment

• Anti-inflammatory medications

• Physical therapy to strengthen surrounding muscles and improve mobility

• Activity modification to limit high-impact activities

• Cortisone injections for targeted joint relief

For more on non-surgical strategies, visit our page on foot and ankle arthritis management.

While effective for many, some patients continue to experience persistent pain despite these approaches.

What Is the Deep Peroneal Nerve?

The deep peroneal nerve travels across the top of the foot and transmits pain signals from structures near the big toe and midfoot. In patients with osteoarthritis, this nerve can continuously send pain signals, even when other treatments are used.

How Deep Peroneal Nerve Resection Works

Deep peroneal nerve resection is a surgical procedure aimed at reducing pain by interrupting the nerve pathway that carries discomfort from arthritic joints. During the procedure:

• A small incision is made on the top of the foot

• The segment of the deep peroneal nerve responsible for pain is identified

• A small portion of the nerve is removed

Because the removed nerve segment primarily carries sensation rather than motor function, this procedure reduces pain without affecting strength or movement of the foot.

This approach is less invasive than joint fusion or other reconstructive surgeries and can allow patients to return to daily activities with improved comfort.

Benefits of Deep Peroneal Nerve Resection

Patients selected for this procedure may experience:

• Significant reduction in chronic arthritic pain

• Improved walking and mobility

• Avoidance of larger, more invasive joint surgeries

• Faster recovery compared with reconstructive procedures

Recovery After Surgery

Recovery is generally quicker than many other foot surgeries. Most patients:

• Wear a supportive shoe or boot initially

• Begin weight-bearing early, as advised by their physician

• Gradually return to normal activities over a few weeks

Comprehensive Care for Foot Arthritis

Osteoarthritis of the foot is complex and often requires a multifaceted approach. Foot and ankle specialists consider:

• Joint mechanics and alignment

• Inflammation control

• Nerve-related pain

• Lifestyle factors

In selected cases, addressing the nerve pathway with deep peroneal nerve resection can provide meaningful relief when other therapies have not fully resolved symptoms.

For more on supportive care, see our guide on custom orthotics for foot arthritis.

Frequently Asked Questions (FAQ)

Q: Will deep peroneal nerve resection affect foot strength?
A: No, the nerve segment removed primarily carries pain signals. Foot strength and movement are typically preserved.

Q: How long does recovery take?
A: Most patients can resume normal walking within a few weeks while using supportive footwear or a boot.

Q: Is this procedure appropriate for all foot arthritis patients?
A: No, it is best suited for patients with persistent pain on the top of the foot or near the big toe joint when conservative treatments have not worked.

Q: Can this procedure replace joint surgery?
A: Not always. It is often considered a less invasive option to reduce pain, but severe joint deformity or advanced arthritis may still require surgical intervention.

Dr. Phil Wrotslavsky DPM, founder of Advanced Foot and Ankle Center of San Diego, is board-certified in foot and ankle surgery and completed an orthopedic fellowship in limb salvage, limb reconstruction, and limb lengthening at the International Center for Limb Lengthening. With over two decades of experience treating complex foot and ankle conditions, Dr. Phil specializes in advanced surgical and non-surgical treatments designed to reduce pain, restore mobility, and improve quality of life for his patients.