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Morton’s Neuroma Surgery

Morton’s neuroma is a painful nerve condition affecting the ball of the foot, typically between the third and fourth toes. It occurs due to thickening and irritation of the interdigital nerve, leading to burning pain, tingling, and numbness in the toes. Patients often describe the sensation as "walking on a pebble" or "electric shocks" in the forefoot.

 

Indications for Surgery

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  • Persistent pain despite non-surgical treatments.

  • Pain aggravated by walking or wearing tight shoes.

  • Numbness or tingling in the toes that worsens over time.

  • Failure of steroid injections or custom orthotics.

 

Surgery is recommended when non-surgical treatments fail to provide long-term relief.

What Does the Surgery Involve?

Morton’s neuroma surgery is performed under local, regional, or general anesthesia. Two main surgical options exist:

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1. Neurectomy (Nerve Removal) – Most Common Approach

  • A small incision is made on the top or bottom of the foot.

  • The thickened nerve is identified and surgically removed.

  • The incision is closed with sutures, and a dressing is applied.

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2. Nerve Decompression (Less Common Option)

  • Instead of removing the nerve, tight ligaments compressing it are released.

  • Suitable for early-stage neuromas where the nerve is not significantly thickened.

 

A neurectomy is more common because it provides a definitive solution, while decompression is only effective in some cases.

Alternative Treatments

Before considering surgery, non-surgical treatments may help manage symptoms:

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  • Footwear Modifications – Wide, soft-soled shoes reduce nerve compression.

  • Custom Orthotics (Insoles) – Metatarsal pads relieve pressure on the nerve.

  • Steroid or Alcohol Injections – Temporary relief but may not provide long-term results.

  • Activity Modification – Avoiding high-impact activities may reduce irritation.

  • Physiotherapy and Stretching – Can help in mild cases.

 

Surgery is considered when non-surgical options fail and symptoms significantly impact daily life.

Risks and Complications

Morton’s neuroma surgery has a high success rate, but some risks exist:

 

General Surgical Risks:

  • Infection (<1–3% risk) – Treated with antibiotics if needed.

  • Blood Clots (DVT/PE) – Rare but possible with prolonged immobility.

  • Nerve Injury – Temporary or permanent numbness in nearby areas.

 

Procedure-Specific Risks:

  • Scar Sensitivity – The scar may be tender, especially with a plantar (bottom of the foot) incision.

  • Stump Neuroma (Recurrent Nerve Pain) – The cut end of the nerve may develop a painful mass, requiring further treatment.

  • Persistent or Recurrent Pain – In some cases, pain may not fully resolve or may return over time.

  • Swelling or Stiffness – Temporary but may last for several months.

  • Altered Sensation in the Toes – Permanent numbness between the affected toes is expected after a neurectomy.

 

Most patients experience significant pain relief and improved comfort in footwear after surgery.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 1–2 weeks

  • Manual labor: 4–6 weeks

 

Return to Driving

  • 2–4 weeks, depending on pain and swelling.

 

Return to Activities & Sports

  • Walking unaided: 2–4 weeks

  • Running or high-impact activities: 8–12 weeks

 

Rehabilitation Timeline

  • Weeks 0–2:

    • Walking is allowed in a post-op shoe.

    • Elevation and ice reduce swelling.

  • Weeks 2–6:

    • Gradual return to normal footwear.

    • Physiotherapy may begin if stiffness persists.

  • 6+ weeks:

    • Resume daily activities as tolerated.

    • Minor swelling may persist for several months.

 

With proper healing, most patients achieve excellent pain relief and improved mobility.

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