Surgery to remove a Morton’s neuroma

What is neuroma?

Small nerves run between the bones in the ball of your foot to supply sensation to your toes. When these nerves become enlarge, thickened or inflamed the condition is called ‘Morton’s Neuroma’. If you have a neuroma you may get burning pain under your foot near the base of your toes. You may also get shooting pains into your small toes or numbness in that area.

What are the benefits of surgery?

These are:

• Pain relief.
• Comfort in your shoes.

What does it involve?

Your operation will be performed as  day case surgery. This means you will be able to go home the same day. However, you must have a responsible adult to take you home and look after you for the first 48 hours.

You operation will be carried out under local anaesthetic. Injections are given around your ankle or behind your knee to numb the skin and deeper nerves. You will be awake during the operation but will not be able to see your operation or feel any pain.

The operation takes about 30 minutes, although you should expect to be in the clinic for 3 hours. This is to allow time before your operation to give you your local anaesthetic and time after your operation to allow you to rest and recover before going home.

During your operation, a small incision (cut) is made in the skin on top of your foot near to the base of your toes. Through this cut the neuroma is found and removed. The incision is closed using sutures (stitches) and covered with a large dressing for 2 weeks.

What happens after my operation?

You will be taken to the recovery area, given a special shoe to wear and shown how to use your crutches. The painkillers you have been given should help, if taken regularly. You should always follow the instructions provided in the leaflet supplied with your tablets. You will be given a leaflet ‘Foot surgery – Discharge advice’, giving advice on how to look after yourself and your foot. You will then be able to go home.

What are the risks and possible complications?

This type of operation is successful for 85 patients in every 100; however, there are risks you need to consider before you agree to the operation. ¹

You should be aware complications are rare, can usually be treated and may not result in you having any permanent disability or pain.

These can include:

• A floating toe. This is where your toe becomes raised due to alteration (changes) of tendons in your foot as a result of your surgery.

• Numbness. Affecting part of your foot and toes where the nerve has been removed.

• Continued pain in your foot.

• A painful ‘stump’ neuroma. This is due to irritation of the nerve end which has been cut. If this happens you may need a further operation.

• Deep vein thrombosis – DVT (blood clots in the leg veins) or pulmonary embolism – PE (blood clots in the lungs).

All adult patients will have their risk of developing a blood clot assessed at their pre-assessment visit. The healthcare professional who carries out the risk assessment will discuss your risk factors with you and advise on treatment to reduce your risk.

You will be given information, ‘Your personal advice for the prevention of venous thromboembolism (blood clots)’, advising you on how to reduce your risk of developing a blood clot.

• Infection of your skin. This can happen to 1 patient in every 83.² Infection of your skin can be easily treated with antibiotics.

• Infection of your bone. This is rare and can happen to about 1 patient in every 2,000. ² This is a more serious complication; you may need another operation to remove the infected bone, a stay in hospital and long courses of antibiotics.

• Delayed healing of the skin on your foot. Although you will be told how long your foot should take to heal, delays in healing of the skin can occur. The information on healing times given to you is a guide only and you should allow for this when planning your recovery.

• Haematoma. This is a painful collection of blood within your foot at the operation site. This occurs very rarely and generally settles without any problems.

• Thick or sensitive scarring of incision.

• Problems with local anaesthetic. A reaction to the local anaesthetic used to numb your foot is rare and can happen to less than 1 patient in every 10,000.²

• Nerve damage. This is usually temporary but can be permanent. Great care is taken to avoid damage to the nerves in your foot during the local anaesthetic and your operation.

• More pain after surgery. This majority of patients who have foot surgery have less pain after their operation. However, you may have no improvement in your symptoms or more pain after surgery.

• Avascular necrosis. This is a very rare complication. It is where part of the bone in your foot loses its blood supply. Your bone may then become weaker, change shape and become damaged resulting in problems such as arthritis in the joint.

• Chronic Regional Pain Syndrome. This is a very rare condition where pain develops in your foot after your operation and does not settle down. If this happens you would need to see a pain specialist.

How long will it take my foot to get back to normal after my operation?

Between 4 to 6 weeks after your operation, your foot will begin to return to normal and you should be able to wear your shoes again. Trainers or flat, loose fitting lace up shoes are the type you should wear. Your foot will still be quite swollen, especially at the end of the day.

Between 4 to 6 weeks you may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again. Your healthcare professional will also advise you.

Between 4 to 6 weeks you can return to work but if you have an active job you may need a little longer time off to recover. Your healthcare professional will advise you when you can return to work.

You should avoid taking part in sport until you are advised by your healthcare professional.

6 months after your operation you will be given an appointment for a final review of your foot. You should now only have slight swelling in your foot and you should be getting the full benefit of your operation.

12 months after your operation your foot should be completely healed.

What other treatments are available?

Other treatments can include:

• Changing your style of shoe.
  
• Wearing insoles inside your shoes to correct the position of your foot.
  
• Steroid injection into your foot may help to reduce swelling and inflammation around your neuroma. You can have up to 3 steroid injections in a 12 month period.
  
• No treatment.

Contact numbers

If you need advice or have any problems please contact the podiatric surgery team.

North Tees and Hartlepool NHS Foundation Trust

Podiatric Surgery
One Life Hartlepool
TS24 7PW
Central booking office: 01429 522471
Monday to Friday, 8.30am to 4.30pm

Further information is available from:

The Society of Chiropodists and Podiatrists
1 Fellmonger’s Path
Tower Bridge Road
London
SE1 3LY
telephone: 020 7234 8620
Or via the website at www.feetforlife.org

NHS Choices
Telephone: 111 (when it is less urgent than 999)
Calls to this number are free from landlines and mobile phones
or via the website at www.nhs.uk

References

1. Coughlin MJ, Pinsonneault T (2001). Operative Treatment of Interdigital Neuroma: A long term follow-up study. The Journal of Bone and Joint Surgery AM, Vol. 83, pages 1321-1328
2. Kilmartin Te (2006). Critical Review: The Surgical Management of Hallux Valgus British Journal of Podiatry Vol 9, no. 1, pages 4-24.

Information used in the development of this leaflet

Miller SJ Nakra A. Morton’s Neuroma. In: McGlamry ED, Banks AS, Downey MS. Matin DE, Miller SJ eds (2004) Forefoot Surgery. Baltimore: Wilkins and Williams, pages 29-50.

Thompson CE, Gibson JNA, Martin D (2004). Interventions for treatment of Mortons’s Neuroma. The Cochrane Database of Systematic Reviews, Issue 3, Online.

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