Surgery for Morton’s neuroma

Surgery for Morton's neuroma

Morton’s neuroma is often painful and a handicap to your daily life. Make the effort to rid yourself of this problem through surgery, and learn more about other treatments that can help ease this unpleasant condition. 

What is Morton’s neuroma?

Morton’s neuroma is a problem due to a thickening of the nerves located between the toes (especially between the 3rd and 4th toes), as a result of continuous compression or friction. The nerve then becomes irritated, and this leads to inflammation.

The nerve begins to thicken until it forms a painful ball that can cause numbness, burning sensations or a sensation of small electric shocks in the toes and forefoot.

Patient expectations

The podiatrist must properly grasp the patient’s expectations regarding the upcoming procedure. However, it is important for the patient to understand that in some cases they may not regain 100% of their foot’s nerve functions. 

Surgery for Morton’s neuroma can sometimes result in a permanent numbness of the toes. In most cases, this sensation decreases over time. 

The surgeon’s top priority during the operation is to relieve the pain. 

When should a patient elect to seek surgery for Morton’s neuroma?

If you can no longer wear your shoes, work or play sports because of your neuroma, you should definitely book a consultation!

And surgery will often be necessary if you have tried various conservative treatment methods with a podiatrist, without success. 

Choosing the right foot surgeon

Overall qualities of a good podiatric surgeon include: 

They are experienced, with a solid reputation: 

Make sure you know your surgeon’s background. They must be able to demonstrate their experience and know-how. Also look for any references received by your professional and verify whether they have any hospital experience. 

They provide personalized surgical care:

You must ensure that the treatment plan is carefully adapted to your needs. The professional you choose must be able to perform complex surgical techniques if your circumstances warrant them, and the surgeon must be familiar with a wide range of procedures.

The surgeon must adopt a humane approach:

There must be a strong bond of trust between you and your surgeon. Your foot care professional must show you respect and compassion. They must listen to you and guide you throughout all stages of your surgery.

The surgeon must be available:

Choose a surgeon who is available and can make time for you. If you need special care, it is very important for them to be available on short notice to assist you.

PiedRéseau provides rapid access to a clinic near you. You will be cared for quickly and each step will be explained to you. 

How do we evaluate whether a patient requires surgery for Morton's neuroma?

Your PiedRéseau clinics can provide you with an evaluation throughout Québec. The local podiatrist can then contact a podiatric surgeon to follow up on your condition. You will be given all the information you need to make the right decision to treat Morton’s neuroma. 

You will be given a customized surgical plan, which you are then free to approve. 

The patient’s medical history is very important

With the history of your pathology, a podiatrist can determine the reasons why Morton’s neuroma appeared on your foot. 

The foot’s morphology or the types of shoes worn are some of the main factors that can determine how the neuroma developed. 

Initial conservative treatment methods

Before electing to have surgery for Morton’s neuroma, it is very important to list what you have already tried or what can be tried. For example: 

  • Wearing wide and proper fitting footwear 
  • Wearing properly adjusted foot orthotics
  • Physical therapy techniques, including massages, ultrasounds and laser therapy
  • Applying ice compresses and taking anti-inflammatory medication
  • Cortisone injections

However, sometimes the situation is so advanced that it is impossible to correct it with conservative treatments, opting instead for surgery to treat Morton’s neuroma. 

Clinical examination

The clinical examination is used to assess whether you are a candidate for Morton’s neuroma surgery. During this part of the examination, the surgeon identifies your surgical history, your medical history, medication and any allergies you may have. 

In addition, a vascular assessment of your feet will be conducted to ensure optimal healing.

X-ray, ultrasound and MRI evaluation of your foot

Generally speaking, the evaluation of your foot is divided into 3 steps:  

X-ray

An X-ray of your bone structure will be taken to establish a surgical plan and ensure that there is no bone pathology linked to your neuroma. 

Ultrasound

An ultrasound is an examination performed in a podiatry clinic or a radiology clinic. This is an important step in making the best diagnosis of your neuroma. 

Other foot conditions appear similar to Morton’s neuroma. A diagnosis through imaging can clearly detect the pain that is radiating through your foot. Following this, a cortisone injection can be administered, with or without an ultrasound, to relieve the neuroma.

Magnetic resonance imaging (MRI)

Magnetic resonance is ideal to accurately measure Morton’s neuroma. This technique allows us to view its aspect, its arrangement or its deterioration. 

In addition, the MRI makes it possible to properly prepare the operating protocol and ensure that nothing has been forgotten.

Why choose surgery performed by a podiatrist?

There are many reasons for doing so: 

  • They have in-depth knowledge of the foot and its biomechanics. 
  • They understand the possible deformations of the foot and how to treat them.
  • They can perform specialized foot interventions.
  • They provide complete management of your foot care.
  • They are able to quickly restore your foot’s maximum autonomy.

Remember that attentive patient follow-up after surgery is directly dependent on the long-term success of neuroma surgery.  

Procedures to remedy your Morton's neuroma

Below are the various ways to proceed: 

Plantar approach procedure (under the foot)

This approach provides direct access to the neuroma under the foot to extract it through an excision. The risk of recurrence with this type of operation is low. 

It is not advisable to choose this solution if you tend not to heal properly or if you have a lot of foot calluses. 

Note that this procedure does not allow you to walk on your foot for a period of 21 to 28 days.

Dorsal approach procedure (top of foot)

The dorsal approach procedure provides excellent results, but can affect the tissue under the bones of your feet more. This is a common method that minimizes the risk of painful plantar scars.

Between the toe procedure

The between the toe procedure completely eliminates the risk of plantar scarring. In addition, it reduces structural stress between the bones in the forefoot. 

However, the surgeon may have more difficulty accessing the neuroma when performing this type of operation. The risk of recurrence is also higher.

Since no single procedure is perfect, it is important to discuss your condition and expectations in detail with your podiatric surgeon. This will help you decide upon the procedure best suited to your condition. 

Chronological steps of Morton’s neuroma surgery

These 4 steps, followed in order, enable your podiatrist to properly treat you: 

Pre-surgery assessment

This step can be conducted several weeks before the procedure. You will be given a treatment plan and have the time to make a clear and informed choice about the desired treatment.

Surgical preparation

This begins a few weeks before surgery:

  • You must obtain medical clearance from your doctor for outpatient surgery. A blood test and prescription for antibiotics before surgery may be required.
  • Sometimes, some patients require a blood test and prescription for antibiotics before surgery.
  • You must allow for a convalescence and rest period following surgery.
  • You must be accompanied by someone for the surgery, and they must be available to assist you for 24 to 48 hours following the operation.
  • Your foot must be properly cleaned.
  • In some more rare cases, fasting is required 12 hours before surgery.

Most procedures take place without IV sedation and general anaesthesia. 

The day of surgery

For everything to proceed as planned, the following must be done: 

  • If required, you must take any medication 2 hours prior to surgery, or as per the instructions of your podiatrist. 
  • Time is set aside for surgical preparation at the clinic. You will then be made comfortable and cared for.

Normally, foot surgeries take place with general anaesthesia and anxiety-relieving medication. 

Back home

To heal properly, you must be aware of some important information to follow after your operation: 

  • The anaesthesia will last for several hours. Pain medication will be prescribed, and you should start taking it while you are still under anaesthesia to prevent feeling any pain.
  • You will return home with the person accompanying you on the same day as the operation.
  • Try to keep your leg elevated as much as possible, and apply an ice pack.
  • You must always keep your foot dry.

It is especially important not to touch your bandages, unless otherwise directed by your surgeon!

Follow-up visits and home care

Each procedure requires special care at home. Follow the personalized home care plan provided by the clinic’s team. A follow-up appointment will also be scheduled, within 3 to 7 days following the operation. 

Stitches will remain in place for 2 to 4 weeks, depending on the individual case. 

What is the convalescence period for Morton's neuroma surgery?

Each situation is different, but you can generally count on several weeks or months before being fully recovered.  

Some more advanced foot surgeries may require using crutches for 4 weeks. Stitches may also last longer in some cases.

Post-surgical plantar orthotics

Morton’s neuroma often develops on feet with biomechanical defects. Wearing foot orthotics is suggested to correct these defects. 

Orthotics also help prevent your other foot from developing the same issues. 

When will I be able to recommence my daily activities?

It all depends on the type of activity performed. For example, if you tend to participate in high-impact sports, you will have to wait longer. Your podiatrist will be able to tell you how long it will take to fully recover.

Always follow the recommendations of your foot specialist

To cure Morton’s neuroma, you must follow your podiatrist’s instructions to the letter. The quality of your healing will have a great impact on your future lifestyle (and on soothing your pain), so you must ensure you follow the healing recommendations given you.

Possible biomechanical complications and special cases

Your podiatrist’s training enables them to recognize and prevent any possible biomechanical complications of surgery. The podiatrist can thus prevent certain new pathologies, such as capsulitis or calluses, from developing.