Morton's Neuroma

Procedure

Neurectomy (Nerve excision).

Aims of surgery

Relieve pain and disability to the forefoot. Improve quality of life for the patient.

Advantages of this operation

Relieves pain and improves quality of life in approximately 80–90% of patients.

Specific risks of this operation

Stump neuroma.
Recurrent Bursae.
Scarring.
Pain at surgical site.
Need for further surgery.
Deep Vein Thrombosis/Pulmonary Embolism.

Operation time

Usually between 15–20 minutes.

Incision placement/stitches

On the top of the foot over the area where the neuroma is located.

Procedure

The incision is deepened to identify the thickened nerve and likely bursae. The nerve is cut near the toes and then traced back under the ball of the foot and the nerve cut out.

Fixation

No.

Will I have plaster?

No.

Is this a day procedure?

Yes, you can usually go home the same day.

Estimated time off work

Non-manual work approximately 4–6 weeks.
Manual work 6–8 weeks.

Indications for the procedure

Pain from beneath the ball of the foot not relieved by conservative care.
Difficulty with shoe fit despite wearing sensible footwear.

Alternative treatments

Manage your symptoms by altering activity levels, using painkillers and anti-inflammatories, extra depth/width shoes, rocker sole (stiff curved sole) using an insole or orthotic foot support, joint injection therapy.

More information

Speak with your consultant.

Morton’s Neuroma/Bursae Excision

The operation can be performed comfortably under a local anaesthetic block, which is achieved by a series of injections around the ankle. You can remain fully awake during the operation and will be able to feel touch, pressure and vibration, but you will not feel any pain. If you do not wish to consider having the operation performed whilst still awake, or your Consultant does not feel this is the best option for you, you will be offered local anaesthetic with sedation or general anaesthesia.

The operation takes about 15–20 minutes although you will be in the day surgery unit for some time before the surgery and afterwards, to allow you an opportunity to rest post-operatively. You must have a competent adult at home for the first day and night after surgery. This allows us to be sure you will be safe for the first night.

Post-Operative Care

First 2–4 days after surgery

This is the time you are likely to have the most pain, but you will be given painkillers to help. You must rest completely for 2–4 days.
You will be able to stand and take weight carefully after the operation with your post-operative shoe on at all times, but you must rest, with your feet up, as much as possible.
You should restrict your walking to going to the bathroom.
You can get about a little more after 2 days.

1–2 weeks after surgery

You may need to attend for your foot to be checked and redressed.
You may start to do a little more within pain limits. Pain and swelling means you are doing too much.

Between 2–4 weeks after surgery

The foot starts to return to normal and you can return to normal shoes (4–8 weeks) (89%).
The foot will still be quite swollen especially at the end of the day.
You may return to work but may need longer if you have an active job.
You may return to driving if you can perform an emergency stop. You must check with your insurance company and Mr. Cichero before driving again.
Whilst normal activity will be resumed, sport should be avoided.

Between 8–12 weeks after surgery