Excision of Morton’s Neuroma

Summary

This operation is performed for symptoms caused by a Morton’s neuroma, a thickening of one of the nerves sitting between the toes.  This can cause pain and tingling to the sole of the foot and affected toes.  Surgery involves removing the Morton’s neuroma or increasing the space around the nerve to reduce the irritation.

Factors to Consider

You have been diagnosed with a Morton’s Neuroma.  It is likely that you have already tried non-surgical treatments for your foot such as pain killers, footwear modification, weight loss and injections.  

If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The procedure can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a small incision over the top of the foot between the affected toes.  The part of the nerve affected is removed.  This causes permanent numbness between the affected toes.  Occasionally the nerve can be released and the space around the nerve increased.  Your surgeon will discuss which option is most appropriate for you to improve your symptoms. The operation takes about 30 minutes.

Anaesthetic

The operation is usually performed under a general or spinal anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

There is a small chance that this operation will not fully resolve your symptoms.  The risk of infection is small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Any surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a bandage and a rigid soled shoe to allow for healing.  You will be able to walk on your foot but it will take a number of weeks before you can wear your normal footwear again.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 4 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 12 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.