dev
mahadevan
consultant foot and ankle surgeon
What is a Morton’s neuroma?
Morton’s neuroma (also termed interdigital neuroma) is a benign thickening of the digital nerve that is believed to be a response to local pressure or irritation (e.g. tight fitting or high heeled shoes). The main symptoms include a shooting, stabbing or burning pain under the ball of the foot radiating to the toes and some also complain of feeling like they are standing on a pebble or marble.
What are the indications for surgery?
In the majority of patients, non-surgical treatment remains highly effective. These include footwear changes (avoiding tight fitting shoes and reducing the height of the heel), insoles and a corticosteroid injection. Surgery is indicated should your symptoms persist or recur following conservative treatment. Surgery involves removing the thickened nerve which reduces the pain but leaves an area of numbness between the affected toes.
What does surgery involve?
This procedure is usually performed as a day case. It is normally performed under general anaesthetic and frequently combined with a local anaesthetic block for pain relief.
A small incision (2 to 3 cm) is made on the top of the foot. The thickened nerve is removed by cutting it out. The skin is then closed using dissolvable stitches and a bulky dressing is applied. You will be allowed to walk on the operated foot in an orthopaedic shoe for the first 2 weeks. It is important to keep the foot elevated as much as possible especially for the first 3 days.
Aftercare and FAQs
You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. You will be followed-up in clinic 12 to 14 days after surgery to check the wound and reduce the foot dressing.
Wound care – The bulky dressing should be kept clean and dry until your clinic appointment.
Walking - You will be able to walk on the day of your surgery unless advised otherwise. You may mobilise freely around the house but long walks or standing for long periods should be avoided.
Work - If you have a sedentary job you should be able to return to work within 2 weeks. If your job is physical, you may need to stay off work for at least 3 weeks.
Driving - You will not be able to drive for 2 to 3 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
What are the surgical risks?
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Infection - there is a small risk of infection with all surgery.
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Swelling - this is quite common. In some people the swelling reduces within a matter of weeks and in others could take a few months.
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Deep Vein Thrombosis - also known as Venous Thromboembolism (VTE), this is a rare complication of foot surgery.
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Scar tenderness
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Residual pain
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Stump neuroma
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.
Research Articles on Morton's neuroma by Dev Mahadevan
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Medium-term results of corticosteroid injections for Morton's neuroma. Foot & Ankle International. 2021 Apr;42(4):464-468
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Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance - a randomised controlled trial. Bone and Joint Journal. Apr 2016, 98-B (4) 498-503.
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What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? Foot and Ankle Surgery. 2016 Mar;22(1):9-11
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Diagnostic accuracy of clinical tests for Morton's neuroma compared to ultrasonography. Journal of Foot and Ankle Surgery. 2014 Nov; 54:549-553.