What is a Morton’s neuroma?
A Morton’s neuroma is when a nerve in the ball of your foot becomes irritated and enlarged. The symptoms of a Morton’s neuroma include a shooting or stabbing pain, the feeling a small stone is under the ball of your foot and numbness or tingling in the toes. The diagnosis based on your symptoms and an MRI or ultrasound scan.
Morton’s neuroma surgery is only recommended as a last resort, once non-operative treatment measures have been exhausted and if your symptoms remain significant.
What is Morton’s neuroma surgery?
In most cases the operation is performed under general anaesthetic (whilst you are asleep). Alternatively, you can have a spinal or regional anaesthetic, which just numbs the leg.
A surgical cut is made on top of the foot over the Morton’s neuroma, the enlarged portion of the nerve is removed and then the surrounding tissues are released. Once the operation is completed the wound is closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery, then a bulky bandage along with a surgical sandal is applied.
What are the risks of Morton’s neuroma surgery?
The risks of any operation generally relate to the anaesthetic and the surgical procedure.
You will be able to discuss your anaesthetic options and associated risks with the anaesthetist before your surgery. With a general anaesthetic, the risks will vary depending on your general health.
The main surgical risks of an ankle arthroscopy are listed below, but it is not exhaustive. These will be further explained in the outpatient clinic.
Swelling and Stiffness– The foot will swell in response to the surgery and the healing process. It takes more than six months for the swelling to completely settle. Some stiffness in the foot may persist.
Infection– The surgical cut usually heals within two weeks. In a small number of cases (less than 5%) the wound becomes infected and antibiotics are required.
Numbness– Some permanent numbness is expected in the web-space of the involved toes, as the nerve has been removed. Most people do not notice the change.
Persistent pain– A proportion of patients (10-20%) can have persistent pain after surgery or their symptoms can recur. It can be due to the cut end of the nerve being irritated (stump neuroma). Revision surgery for this complication does not always have a reliable outcome.
Infection– The wound usually heals within two weeks. In a small number of cases the wounds become infected. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.
Blood clots (leg or lung) – There is small risk of developing a blood clot after foot surgery. Measures are taken to reduce the chance of this happening but cannot be completely avoided.
Chronic regional pain syndrome – Following Morton’s neuroma surgery a small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.
What happens after my operation?
When will I go home after surgery?
Most patients can go home on the same day of surgery. You may require an overnight hospital stay, if you have other significant medical problems.
Can I walk on the foot?
After the operation you can fully weight bear through the operated leg. Before you go home the physiotherapist will make sure you are safe to get around on crutches. It is important to wear the surgical sandal continuously to protect the operated area.
In the first few weeks keep your leg elevated as much as possible to help reduce the swelling and aid wound healing. It is important that your bandage remans dry and you may find using a waterproof cover helpful (www.limboproducts.com).
When will I be followed-up in clinic?
You will be seen two weeks after surgery in the outpatient clinic. Your wounds will be checked and the stitches removed. If the wound has healed, you can then start wearing your own footwear. An accommodative soft trainer is best. You will be referred to our specialist physiotherapists. You will then be seen again six weeks after surgery to check on your progress.
When can I go back to work?
If you have a sedentary job (desk based) and can elevate your foot, you can return to work two weeks after surgery. If you have a more physically or strenuous job you may need longer off work.
When can I drive?
You can start driving when you are comfortably walking in your own footwear. If you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. Start by sitting in the car and trying the pedals, then drive round the block. Drive short distances before long ones. If you are having surgery on your left leg and drive an automatic car, you could consider driving sooner, but only if you are safe to do so.
When can I return to full activity levels?
It varies how quickly people can take up exercise again. You should though avoid high impact exercises for at least six weeks and return gradually as your comfort levels allow.
When can I fly after surgery?
If you are flying after recent surgery you are at an increased risk of developing a blood clot in one of the deep veins in your body, usually the leg (deep vein thrombosis or DVT). Please ask your surgeon for individual guidance on how long to delay flying after your surgery. Also, each airline has its own regulations about flying after surgery and you will need to check with your airline before flying.
Patients that have a healthy diet, take regular exercise and refrain from smoking are more likely to experience a quicker recovery with a more successful outcome from their surgery.
Taking vitamin C supplements for six weeks before surgery and six weeks after surgery can also be beneficial. You can purchase them from your local pharmacy or supermarket.
If you have any concerns about your general health and well-being (diet, exercise, smoking cessation) you are encouraged to discuss this with your GP, who will be able to provide advice on the options available to you.
We hope this leaflet has answered any questions you might have. If you have any further queries, please feel free to discuss them with any of the medical or nursing staff.