The majority of people with Morton’s neuroma are able to find relief with conservative treatments, which may involve a change in footwear (wearing shoes with wider, stiffer soles that are well padded and low heels), custom orthotic therapy, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, alcohol injections, or a combination of these therapies.
If conservative treatment does not relieve your symptoms, however, you may require a Morton’s neuroma excision.
Most patients who undergo a Morton’s neuroma excision, in which the neuroma and part of the nerve are removed, will experience complete relief from pain but will suffer some permanent numbness of the adjacent toes.
Other complications associated with this surgery are described below. While surgery is successful in many cases, the reported long-term outcomes of neuroma excision vary. The outcome may depend on the location of the neuroma, and on which web space is affected.
Surgery to correct a Morton’s neuroma can be done in your podiatrist’s office with local anesthesia or with IV sedation and local anesthesia.
It is an outpatient procedure, which means that you are able to go home the same day. Morton’s neuromas in both feet can be corrected at the same time, or in two separate procedures.
When Is Morton’s Neuroma Excision Appropriate?
Your podiatrist may discuss surgical treatment options with you if your symptoms have persisted or worsened after trying multiple conservative treatments.
Surgery is rarely needed for people suffering from Morton’s neuroma, and alcohol injections—direct injection of dilute alcohol (4%) into the area of the neuroma—are successful in most cases.
Preparing for Morton’s Neuroma Excision
Follow your surgeon’s instructions regarding preparation for surgery. You will need to complete any pre-operative tests or laboratory work prescribed by your doctor.
You may have to refrain from taking aspirin and NSAIDs for one week prior to surgery and refrain from eating or drinking anything after midnight the night before surgery.
Make sure you understand the risks and benefits of the surgery and discuss any concerns with your surgeon.
On the day of your surgery, arrive on time and have someone drive you to and from the doctor’s office, or arrange for someone to pick you up.
How Is Morton’s Neuroma Excision Performed?
Before the surgery, you may be given some form of sedative anesthesia, and a local anesthetic will be injected into the affected area of the foot. IV sedation requires the assistance of an anesthesiologist to administer the medication and monitor your vital signs.
To remove a neuroma, a small incision is made in the web space between the two affected toes. Traditionally, the incision has been done on the dorsal side, or top, of the foot, although it can be done using a plantar approach (through the bottom of the foot).
Your surgeon will continue the incision deeper between the metatarsals (the bones behind the toes) to locate the neuroma. The neuroma is dissected free of the nerve to which it is attached and excised. A portion of the involved nerve is also removed (neurectomy).
The wound may be closed with an absorbable suture or with stitches, and the foot is wrapped in a compressive dressing. The dressing holds the foot securely in place, much like a cast, to allow healing.
The dressing should be kept on until the first post-operative office visit, which is usually 10 to 12 days after surgery, when your surgeon will change or remove it.
Other types of procedures for Morton’s neuroma include:
- Intermetatarsal ligament release (decompression): This is a simple operation to release the ligament between the metatarsal bones. The goal is to reduce the squeezing action by the metatarsals and remove the irritation on the nerve by the ligament. This procedure will not cause any residual numbness in the toes.
- Cryogenic neuroablation or cryo injection therapy: During this procedure, extremely cold temperatures are applied to the nerves to destroy nerve cells and the myelin sheath that covers the nerve. Patients who have cryogenic neuroablation are less likely to see symptoms return.
- Metatarsal osteotomy: This surgery involves cutting the metatarsal bone of the big toe and realigning the bone. It is often used to treat bunions but may be used for intermetatarsal neuroma if the metatarsal is malpositioned or malformed.
After Morton’s Neuroma Excision — What to Expect
You will be given a prescription for a pain medication, such as acetaminophen. Patients are often given a post-operative shoe to wear. You will be instructed to keep your foot and leg elevated while sitting or lying down and make sure your bandages are clean, dry, and intact, even when bathing.
Most patients have swelling of the foot for a few weeks after surgery. The motion of the toes may be limited while swelling persists.
The stitches are removed within two weeks of the surgery, and most patients can walk without crutches or other assistive devices directly after the procedure. Some mild bruising and bleeding is normal after foot surgery.
During your recovery, gradually increase the amount of weight you apply to the foot during normal activities. After the incision is completely healed, massaging the forefoot can help prevent the development of scar tissue. Formal rehabilitation is not usually necessary. Complete recovery typically takes three to six weeks.
What Complications Are Associated with Morton’s Neuroma Excision?
The most common complication of Morton’s neuroma excision is numbness in the toes, which may be permanent and can cause problems with footwear. Another risk of this surgery is a scar tissue or stump neuroma, which develops when there is irritation at the end of the cut nerve.
This can cause numbness, tingling, or pain similar to what you had before the surgery. Other possible complications include wound infection and delayed healing, worsening of pain, and recurrence of the neuroma.