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What is it?
Morton’s neuroma is referred to a painful swelling of the nerves that are present underneath the ball of the foot. They are commonly found in the webspace between the 3rd and 4th toes. If the persist to cause pains despite no-operative treatment, then you may need them excised.
What does the surgery involve?
Surgery is performed through the top of the foot where a small incision between the toes is made to access the nerve. Often there is an associated bursa which is also removed (see above).
I perform this as a day surgical procedure and under general anaesthetic. You will have a local anaesthetic block which means that the foot will be numb and pain free after the surgery. This will last for most of the first 24 hours. The incision is closed using absorbable sutures.
You will have a bulky bandaging but no plaster cast or boot. A flat surgical sandal is provided for you so that you can walk to go home without getting the bandages dirty.
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 injections of cortisone in and around the painful nerve. There are other less conventional treatments such as alcohol injections or laser therapy which some clinicians perform.
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 are the risks of the operation?
This information needs to be read in conjunction with the document on “general risks of foot and ankle surgery” but some of the specific risks of Morton’s neuroma surgery are discussed in more detail below.
What does the post-operative period look like?
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 or a chair.
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 a pair of 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.
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 lower impact activities such as cycling, or swimming may be possible as early as 6 weeks. The timelines vary from person to person and some patients can return much earlier.
SHOWER – you can get your 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 bandaging and prevent it from getting wet.
