Morton Neuroma

What is a Morton Neuroma?

Morton’s neuroma is a common condition that causes pain in the ball of the foot and sometimes the toes.  The pain is due to a swelling on the nerve (neuroma).  Shoes with a narrow toe and high heel will make your symptoms worse.

Usually patients suffer from some of the following symptoms:

  • Pain in the ball of the foot
  • Pain in the middle toes
  • Numbness or “dead” feeling in toes
  • Intermittent pain worse on walking
  • A particular pair of shoes is worse
  • Relief from pain is found by removing shoe and rubbing the foot
  • Pain can last months or years

 

An ultrasound scan of your foot may be requested to identify the precise site of the swelling and its size.  This can be helpful in deciding what to do in the way of treatment.

 

Why do you need this operation?

In most instances your symptoms can be managed adequately with a combination of the following: well-fitting shoes with a low heel and a sturdy sole, insoles specially designed to support the bones in your foot or a steroid injection.

This operation is offered to you if you continue to suffer significant discomfort despite the above measures and after being examined and counselled.

This operation is usually successful in alleviating the pain of this condition in about 75 – 80% of patients.

 

What does the operation involve?

The operation is done as a day case but come prepared in case you need to stay overnight.

The operation is normally performed with general anaesthetic with a nerve block (which means numbing the nerves of the foot). The operation involves removing the nerve through a small incision on the top of your foot.

In recurrent neuroma surgery sometimes the incision is performed from the sole of the foot.

 

Your post-operative period

  • You will have a bandage on your foot
  • You will go home with a surgical sandal on your foot
  • You must keep your foot raised for the first week and when necessary afterwards
  • You can put your full weight on your foot when comfortable
  • Crutches may be provided if needed
  • The swelling may last for a few weeks after the operation

 

Your follow-up

  • After two week the stitches are removed and the dressing is reduced
  • You are seen again at six – eight weeks
  • Off work for one or two weeks depending on your job
  • Into wide fitting shoes at two – three weeks.
  • No driving for two weeks

 

What are the possible complications?

  • Infection
  • Numbness / altered sensation between the affected toes
  • Ongoing pain
  • Recurrence of symptoms in 20-25% of patients
  • Persistent pain and swelling for several months
  • Sensitive / painful scar
  • Occasionally clawing of the toes may occur after surgery
  • Complex Regional Pain Syndrome
  • Injury to the blood vessels of the toes
  • Clots in leg (DVT)
  • Clots in the lung (PE)

 

If you are having excision of two Morton Neuromas from the same foot, the sensation in the third toe will be lost completely. This is usually well tolerated by patients.

 

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood-thinning medication increases possible risks significantly.