Introduction

Morton’s neuroma is a thickening of the interdigital nerve, which supplies feeling to the toes. This nerve runs between the metatarsals (bones) in the foot.  If the nerve is swollen it may become irritated, causing pain which goes into the toes. 

Diagnosis

Your surgeon will take a thorough history and physical examination of your feet.  Further investigations such as X-rays and ultrasounds may be required.  Patients with Morton’s neuroma often complain of a burning or tingling pain in the toes.  This is much worse when wearing shoes.  Often taking your shoes off and rubbing your foot will relieve your symptoms. 

Treatments

• FootwearModification:
  Wide deep shoes that are comfortable may improve your symptoms.

• Cortisone Injection:
  Cortisone can be injected around the nerve to lessen inflammation and swelling.  Although this may improve symptoms, this is often only temporary.

Before Surgery

Anti-inflammatory medications such as Aspirin, Brufen, Voltaren, etc. should be stopped 10 days before surgery.  If you are taking any blood thinners, for example, Warfarin, Plavix or Iscover, stopping these should be discussed with your surgeon.  It is ideal if smoking can be ceased prior to surgery.  

It is also advisable to prepare circumstances at home prior to your surgery, as there will be a period of recovery and rehabilitation following your surgery.  Arranging for family and friends to assist you in the home setting is highly recommended. You should ensure that there is adequate clearance in the home to enable you to use a crutches or walking frame.

It is important that you organise family and friends to assist you with transport, as you will not be able to drive for at least 2 weeks. 

Surgery

Surgery involves removing the swollen part of the nerve.  This leads to a loss of feeling in the web space adjacent to the nerve.  It also relieves the pain caused by the Morton’s neuroma. 

Surgery involves a general anaesthetic and a nerve block to provide post-operative pain relief.   A small incision is made on the top of your foot at the base of the toe. The swollen nerve is identified and removed. 

After Surgery

You will be in a bandage and require a post-operative shoe for up to 2 weeks.  Your mobility will be limited by swelling and discomfort.  It is important that you rest in between walking to allow the pain and swelling to settle.  At home, initially walking is kept to a minimum.  You will require assistance with household chores such as cooking and cleaning. 

After 2 weeks the dressings are removed, it may take another 2 weeks to be comfortable in closed shoes.

Driving is not allowed when in the post-operative shoe, but may be resumed when comfortable, particularly when you are able to brake in an emergency, usually at the 3 week mark following surgery.

Returning to work can be dependent upon the activities of your employment, but is usually resumed at anywhere between 2 weeks and 6 weeks following surgery. 

Risks of Surgery

Morton’s neuroma surgery does involve risk.  Risks include infection, recurrence of the pain, prolonged swelling and metatarsalgia (ball of the foot pain).