Excision of Morton's Neuroma

The cause is not fully understood, but local compression with tight or high heeled shoes plays a role and certainly makes the symptoms worse. It can sometimes be treated with simple measures such as calf stretchers, comfortable shoes, weight loss, insoles, and simple painkillers. If these measures do not work, an ultrasound scan may be requested, and an injection of local anaesthetic and corticosteroid can be tried. If the response is not satisfactory, you may require more than one injection. If this is still not sufficient to control your symptoms, the trapped nerve can be surgically removed.

• The foot tends to swell after surgery as part of your body’s natural response to injury/surgery, and as it is at the bottom of your body, fluid tends to collect in its tissues anyway. It varies how quickly this swelling disappears and four to six months is not unusual. Provided you do not have undue pain or inflammation there is nothing to worry about and you should give it time.
• The wounds usually heal quickly, but occasionally these can become infected and need antibiotics.
• As the trapped nerve has been excised, the sides of the two toes it supplied will be permanently numb. Some people find this slightly strange but generally become accustomed to it.
• The end of the cut nerve can become trapped or inflamed and causes continued pain; further surgery may be necessary.

General operation risks include:

• Blood clots.
• Anaesthetic complications.
• Tourniquet complications.
• Pain, swelling and stiffness (chronic regional pain syndrome – CRPS).

Most patients find simple measures can make a big difference to the outcome of surgery. The evidence from studies and our experience supports this:

• Take simple Vitamin C and vitamin D tablets for healing.
• Stop smoking (smoking slows down healing and is linked to an increased likelihood of complications).
• Keep fit and a healthy weight; many foot problems are improved by losing weight.

Excision of a Morton’s neuroma can be done as day case surgery. You will be able to go home the same day and must arrange for someone to drive you.

It can be performed under general or local anaesthetic. Your anaesthetist will advise you about the best option for you:

General anaesthetic. A local anaesthetic may be injected into your leg or foot while you are asleep to reduce the pain after the operation even if you go to sleep for the surgery.

For the first 24 hours:

• Someone should stay with you until the general anaesthetic has worn off.
• Do not drive, operate machinery, or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
• Do not sign any legal documents or drink alcohol.

Local/regional anaesthetic. You will be given an injection in the back, leg or around the ankle to make the foot numb while you remain awake. Local anaesthetic injections do not always work, and your consultant may need to put you under to continue with the operation.

A cut is made on top of the foot between the metatarsal bones. The swollen nerve is identified, and a short section is removed. The incision is stitched up and your foot is dressed in a firm bandage, not plaster. You will also be given pain­killing tablets as required.

Walking

For the first 14 days you should avoid walking, if possible, but if you need to walk put all of your weight on the heel. When not walking, you must rest with your foot elevated to reduce swelling.

You will be seen in the clinic approximately two weeks after your operation. The dressings will be removed, the wound examined, and the stitches removed. You will then be more mobile and able to walk on your whole foot using crutches to support you. Another clinic appointment will be made for six to eight weeks later.

Going back to work

Your surgeon or a member of the foot and ankle team will advise you about going back to work as it depends on what you do and how you get there. If you need to drive to work, this will affect when you can go back.

If you have a static job that you can do with your foot in bandages, you can probably go back to work two to three weeks after surgery.

If you have a heavy manual job, you may need to be off for up to two months.

Driving

Once your bandages have been removed you may be able to start driving again. If you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident so you must be comfortable and not too stiff. Start by sitting in the car and trying the pedals. Then drive round the block. Drive short distances before long ones. Your surgeon or a member of the foot and ankle team will advise you about when you are safe to drive again.

Sport

After your dressings have been removed you can start gently exercising your foot and walking further each day. When you are comfortable doing this, you can start gentle running and stretching. Contact, twisting and impact sports can follow as comfort dictates. Everyone is different so be guided by your own body’s reactions and the advice of your surgeon. Most people can get back to their previous activities within three months of Morton’s neuroma surgery.