Morton's Neuroma
What is a 'Morton's' neuroma ?
A Morton's neuroma may cause pain and numbness in the toes and forefoot. It most commonly occurs between the 3rd/4th toes (80%) or the 2nd/3rd toes (20%). It is due to compression of the nerve between the 'knuckles' of the foot, the nerve becomes thickened producing a nodule or 'neuroma'. This is why the pain is often worse when the feet are squeezed in shoes.
What does surgery involve ?
Surgery involves excising (cutting out) the nerve. This is performed through an incision over the top of the forefoot, between the corresponding metatarsal heads (knuckles). Following the surgery, you will be in a bulky dressing and a post-operative shoe. The foot must be elevated (above the level of the pelvis) for 90% of the time for 1 week. This helps to reduce swelling and the risk of infection, and helps wound healing. Naturally, short periods of walking/standing are allowed. The dressing should be replaced at your GP practice after 3-4 days. The post-operative shoe should be worn for 2 weeks when walking.
What are the risks of surgery ?
Stiffness & swelling
Initially the foot will be swollen and needs elevating for 1 week. The swelling will disperse over weeks/months but may still be apparent at 3 months. Often shoes will remain tight for 8-12 weeks.
Infection
Any surgical wound can become infected. If there is an infection it normally resolves with a course of oral antibiotics. Very rarely, further surgery is required.
Numbness
The intention of the surgery is to remove the nerve / neuroma. This will cause permanent numbness in the
toes. With time the area of numbness may reduce a little.
Recurrence
There is approximately a 5% risk of the symptoms and neuroma recurring. This may require further surgery.
Failure to relieve all symptoms
The neuroma may not be the only cause of your pain. Any residual pains are usually due to problems within the neighbouring metatarsophalangeal joints. These pains are usually relieved with insoles.
How long will i be off work ?
2 weeks off work for sedentary jobs
6 weeks off work for standing/walking jobs
A sick note is usually provided for the first 2 weeks; further notes can be obtained from your GP.
What is the usual follow up ?
2 week appointment for the removal of sutures.
Article written by
Mr Henry Atkinson
Consultant Orthopaedic Surgeon
North London Sports Orthopaedics
Last updated 16/3/10
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