If symptomatic, a Morton’s Neuroma can be excised to treat the symptoms. In the correct patient when the diagnosis is established then surgery can be very successful in eliminating pain.

What are the alternatives to surgery?

Surgery is not always required. Treatment alternatives include orthotics (insoles to relieve pressure), change of footwear or avoidance of pain inducing activity and also injections of cortisone in and around the painful nerve.

It is also important that one has established confidently that the thickened nerve or neuroma really is the cause of the pain. This is because studies have shown that nearly half of the population may have a nerve that is enlarged on imaging scans but is not causing any symptoms.

What does Surgery Involve?

The operation is performed as a day surgical procedure. It can be done under local anaesthetic although if you are fit and well we do prefer a short general anaesthetic  for the procedure. The operation takes between 20-30 mins.

A thigh tourniquet is often used to stop blood obscuring the field of vision. You may notice some bruising or discomfort around the thigh for the next day or two after the operation as a consequence.

The painful space is premarked. This is commonly the “third space” ; the space between the 3rd and 4th toes. A longitudinal incision is made and the soft tissues are dissected and released to exposed the painful nerve. The branches to the corresponding two toes and the main trunk of the nerve together with any surrounding bursa or scar tissue is also removed.

Intraoperative photos showing the exposure and incision required to explore the webspace for a neuroma.

This is usually sent to the lab to confirm the diagnosis.

Example of a neuroma after excision.

The wound is then closed with absorbable sutures and a bulky dressing used.

What are the risks of Surgery?

INFECTION-

This can occasionally (rate 1-2%) occurs as with any operation. Antibiotic therapy or occasionally surgery to wash and clean the wound may be necessary.

NUMBNESS or NERVE INJURY-

This is an expected outcome of the surgery as the nerve that is supplying sensation to the toes is being removed. In practice the area of numbness is small and not of any consequence. Occasionally however the whole toe can go numb.

LACK OF BENEFIT or RECURRENCE –

In a proportion of patients the pain may not improve or may return after a period. This may be cause the initial pain pathology was not the nerve or that the nerve has re-grown. Fortunately this happens in around 5% or less if the correct diagnosis has been made.

THROMBOSIS- 

COMPLEX REGIONAL PAIN SYNDROME (CRPS)-

This is a rare complication that can result in post op pain and skin colour changes in the whole of the foot and sometimes the entire lower leg. It occurs in less than 0.5% but can result in a poor outcome and prolonged recovery.

What happens after the surgery?

WEEKS 0-2
You will have post operative bandaging on your foot but will be able to walk fully weight-bearing in a post operative sandal. Although crutches maybe used they are not necessarily needed. In this time it is important to keep the leg elevated above heart level as frequently as possible although you should not be confined to bed.
You can go to work after a few days if your work is sedentary and desk based and your commute is not difficult.

WEEKS 2-6
You will be seen at the two week mark for removal of the bandaging and a wound inspection. At this stage it is likely that you will be able to graduate to normal shoes although a pair of trainers or comfortable and wide fitting shoes are advised.
There would be residual pain and swelling that would be ongoing but gradually improving.

WEEKS 6-12
The postoperative pain and swelling will slowly resolve in this period and you are able to return to most of your day to day activities although return to sports or high impact activities may only be possible towards the end of this period.

When can I start my routine?

WORK- we recommend between a few days to two weeks off work depending on how physical your work is and what your commute to work is like.

SPORTS- most sports can commence by 3 month post op although some low impact activities such as cycling may be possible as early as 6 weeks.

SHOWER- you can get you foot wet after the two week visit when the bandaging is removed and full wound healing confirmed. Before this you need to shower with protective covering to waterproof the dressings and prevent it from getting wet.

Further Information

We recommend the following links for further information on the surgery:

Patient information leaflet from Guy’s and St Thomas’ Hospitals NHS Trust

Information from NHS Choices website