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.