Endoscopic decompression for forefoot nerve entrapments is discussed in this article from not only the perspective of preoperative indications, intraoperative technique, and postoperative management, but with reference to the changing paradigm for management of this condition. Surgical results are discussed and compared with other published reports. Complications of the surgical technique are also discussed, which will give the operating surgeon a frame of reference when comparing decompression procedures to those techniques involving nerve resection. There is also a valuable discussion of current methods of diagnosis that may help the practitioner improve patient outcomes.