Morton’s Neuroma Surgery

It is not a tumour and only requires treatment if painful or bothersome. It can cause pain and numbness in the toes and forefoot and most commonly occurs between the 3rd and 4th toes (80%) or the 2nd and 3rd toes (20%).  It occurs due to chronic compression of the nerve between the ‘knuckles’ of the foot. Gradually, the nerve becomes thickened (fibrosis) producing a nodule or ‘neuroma’. Generally, treatment begins with a steroid injection and provision of insoles (orthotics) before considering surgery.

Surgery involves excising (removing) the nerve including the part that is damaged and swollen.  This is performed through an incision on the top of the forefoot, between the corresponding metatarsal heads (‘knuckles’).  Following the surgery, you will be in a bulky dressing and a post operative shoes.  It is essential that the foot is kept elevated for the first ten days.  

Morton neuroma is the name given to a benign thickening of one of the sensory nerves within the forefoot. Nerves are the electrical wiring in the body controlling sensation, muscle function, and just about all processes in the body are influenced by nerves in some way.

General Recovery Facts Morton’s Neuroma

• You can expect mild to moderate pain for a few days

• You can walk on the foot (heel) straight away following surgery

• Patients are usually able to wear a training type shoe by 2-4 weeks

• The toes will remain puffy / swollen for about 3 months

• Massaging the foot during the first 3 months from surgery is important

Post-operative Course: 

Morton’s Neuroma Excision

Day 1 

• Foot wrapped in bandage and surgical shoe

• Start walking in surgical shoe

• Elevate, take pain medication 

• Begin moving the toes as comfort allows

• Expect numbness in foot 12-24 hours 

• Blood drainage through bandage expected  - Do not change bandage 

• You can remove surgical shoe when seated and in bed at night 

• You may drive with caution in the surgical shoe ONLY IF surgery to left foot only and automatic vehicle (otherwise return to driving at 3-4 weeks post surgery)

10-14 Days 

• Follow-up in the outpatients for wound review & removal stitches

• Dressing changed 

• Shower when incision healed

• Begin to walk in ordinary soft training shoe depending upon comfort 

8-12 weeks 

• Follow-up in the outpatients 

• Return to sports (some may return by 4 weeks post surgery but usually 8 weeks)

• No high heel is worn for three months post surgery 

Main Risks of Morton’s Neuroma Surgery:

Swelling– Initially the foot will be very swollen and needs elevating.  The swelling will disperse over the following weeks and months but will be apparent for up to 6-9 months.

Infection– This is the biggest risk with this type of surgery.  Smoking increases the risk 16 times.  You will be given intravenous antibiotics to help prevention.  However, the best way to reduce your chances of acquiring an infection is to keep the foot elevated over the first 10 days.  If there is an infection, it may resolve with a course of antibiotics.

Wound problems– Sometimes the wounds can be slower to heal and this does not usually cause a problem but needs to be closely observed for any infection occurring.

Scar sensitivity– The scars can be quite sensitive following surgery but this usually subsides without treatment. If persistent sensitivity occurs then this can be treated.

Nerve Problems– The web space from which the nerve is removed will be permanently numb. This does not bother most patients but the web space should subsequently be checked regularly by the patient when bathing to ensure no skin problems as they will not have protective sensation here.

CRPS– This stands for complex regional pain syndrome. It occurs rarely (1%) in a severe form and is not properly understood. It is thought to be inflammation of the nerves in the foot and it can also follow an injury. We do not know why it occurs. It causes swelling, sensitivity of the skin, stiffness and pain. It is treatable but in its more severe form can takes many months to recover.

Deep Vein Thrombosis (DVT)– This is a clot in the deep veins of the leg and the risk of this occurring following foot and ankle surgery is low (generally< 1%). The fact that you are mobile after surgery and able to take weight through the heel of the operated foot helps to minimise this small risk. However, it is sensible to try and move the toes and the ankle regularly following the surgery and probably also sensible to avoid a long-haul flight in the first 4 weeks following surgery. If a deep vein thrombosis (DVT) occurs then you will require treatment with heparin and Warfarin to try and prevent any of the clot travelling to the lungs (pulmonary embolus / PE) which can be much more serious).

Continuing symptoms– Most people (90%+) are very happy with the results of their neuroma surgery but you can appreciate that if some of the above problems occur then this may also affect the end result. Occassionally, the neuroma can recur (~5%) and this can be a difficult problem to treat. This is often called a stump neuroma. Results of further surgery to remove a stump neuroma are not usually very rewarding. In Mr Redfern’s experience the risk of this occurring is very low as long as the surgeon removes sufficient length of nerve.

Sick Leave

In general 2 weeks off work is required for sedentary employment, 6 weeks for work involving standing or walking, and for manual labour work.  We will provide a sick certificate for the first 2 weeks; further notes can be obtained from your GP.

Driving

May return to driving after outpatient review at 2 weeks post surgery ONLY IF left leg surgery only and automatic vehicle – otherwise unable to drive until 4 weeks post surgery. 

These notes are intended as a guide and some of the details may vary according to your individual surgery or because of special instructions from your surgeon.