Morton’s Neuroma

Anything that causes compression or irritation of the nerve can cause a neuroma. The exact causes are still unknown.

Ill-fitting footwear: Shoes with narrow toe box, high heeled shoes, or shoes with pointed toes.

Physical Activity: Being active and playing high impact sports like running or racquet sports and placing high pressure on the forefoot can lead to Morton’s Neuroma. Similar to the repetitive traumatic stress that professional ballet dancers undergo.

Foot deformities: Pes planus (flat foot), bunion, hammer toes, tight calf muscle (equinus deformity).

Conservative

Padding: Padding techniques to support for the metatarsal arch, thereby reducing the pressure on the nerve and decreasing the compression when walking.

Icing: Placing an icepack on the affected area helps reduce swelling.

Orthotic devices: Custom orthotic devices provide the support needed to reduce pressure and compression on the nerve.

Activity modifications: Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.

Shoe modifications: Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.

Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

Injection therapy: Treatment may include injections of cortisone, local anesthetics, or other agents such as sclerosing alcohol injection.

Radiofrequency Ablation: The pathologic nerve is heated with heating needles so it can no longer transmit pain. This is usually done by a specialist interventional radiologist.

Surgical

Morton’s Neuroma surgery (neurectomy – removal of nerve) can be done as a day surgery procedure as it only requires a small incision of 2–3cm on the top of the foot.

Surgical excision of a Morton’s neuroma has good clinical results and high overall patient satisfaction in the long term.

Do I need surgery? – Surgery is advised if conservative treatment fails. Although your doctor may recommend an operation it is your decision if you go ahead with the operation or not.

Duration – The surgery usually takes between 15-20 minutes to complete, and patients can return home the same day.

Anaesthesia – Morton’s Neuroma surgery can be performed under general anaesthesia or intravenous sedation depending on the doctor’s and the patient’s preferences.

Medications – Your doctor or anaesthetist may give you antibiotics during the operation to reduce the risk of infection.  Your doctor will discuss pain medication.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications.

Patients must follow their doctor’s instructions carefully during recovery to ensure proper healing and minimize the risk of complications.

The following should be adhered to in order to hasten your recovery from foot surgery.

In general, the following timeline can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. Take pain medication as instructed and avoid smoking. Wear post-operative shoe all the time, even at bed for the first 2 weeks. Place a plastic bag over your foot when showering.

Some blood ooze can be expected in the bandage, but if worried, contact the number given.

The first few days: This is the worst time for pain. You must rest completely for the first 2-4 days. When you are resting, keep your operated foot elevated just above hip level as much as possible.

You may be advised to keep the circulation going by gently drawing circles in the air or wiggling your toes.

You should restrict your walking to minimal activities such as going to the bathroom only. You may be able to bear a little weight on the heel in the postoperative shoe.

1-2 weeks: You may start to do a little more within pain limits, but still restricted. Pain may mean you are doing too much.

In the first 2 weeks, keep the foot dry until stitches are removed.

You may be able to gradually return to wearing comfortable tennis shoes between 2-3 weeks.

2-4 weeks: Stitches are removed. For absorbable stitches this normally means just trimming the ends. You should no longer need the bandage and be able to get around a little more.

You may have a shower and provided that the wound is well enough healed, you should be able to get your foot wet.

Your foot will still be quite swollen, but you should be able to get a roomy shoe on, otherwise stay in the post-op shoe. You should bring a lace up broad fitting and supportive shoe (ideally a trainer) to your review appointment with Dr. Kim.

You will be advised on incremental return to activity and may also be advised on scar care.

Do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen, or sore, you need to see your surgeon.

4-6 weeks: You can return to normal shoes if no pain. The foot will still become swollen especially at the end of the day, or if you do too much weightbearing.

8-12 weeks: Your foot should continue to improve and begin to feel more normal again. There will be less swelling. Sports activities can be considered depending on your recovery.

You will have a post-op appointment 12 weeks after surgery for a routine check-up and any follow up questions.

Rest – 1-2 weeks (minimal weight bearing for essential things only like bathroom breaks 5-10 minutes maximum per hour)

Walk – 2-4 weeks (movement limited outside of house)

Driving – 2-4 weeks (for any hospital procedures under general anaesthesia, you cannot drive until after 24 hours when you are off narcotics. Therefore, you will need someone to drive you home from hospital)

Return to sedentary work – 1-2 weeks (If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet)

Return to active work – 4-6 weeks (If you have a physical job or are standing a lot and unable to elevate your foot/feet)

Low impact exercise – 4-6 weeks (slow walking, cycling, golf using a caddie)

High impact exercise – 8-12 weeks (fast walking, running, jumping, playing sport)

As with any surgical procedure it is not without complications. Specific complications for this surgery include – Infection and Scar tissue, Regrowth of neuroma 10% of the time, within a short period of their removal. Should this occur, further conservative or surgical treatment may be necessary.