Morton’s Neuroma Surgery
Surgery
Surgery to correct a Morton's neuroma is done as an outpatient. It can be done with a general anesthetic or an ankle block. If both feet have Morton's neuromas they can be corrected at the same time, or they can be done singly. Most people choose to have both sides corrected at the same setting so they only have one anesthetic, and only one recovery period. I routinely allow you to walk with all of your weight on the operated foot, so it is possible to have both sides done and still be able to get around. Some patients have other forefoot problems, such as bunions, hammertoes or bunionettes that can also be treated at the same time.
During the surgical procedure a skin incision is made on the top of the foot at the base of the webspace where the neuroma has been identified. That incision is generally about 1 inch in length. The nerve is cut, and the neuroma sent to the pathologist.
Day of Surgery
At the end of the surgical procedure the wound is covered and the foot is wrapped with a dressing that is securely taped into place. That dressing gives support to the foot, acting like a cast to hold it securely. That dressing should be left in place until I change it at the first post-operative office visit.
You will be given a post-operative shoe at the surgery center, and you may put all of your weight on the foot if you have that shoe on. You must not walk on the operated foot unless you are wearing the post-operative shoe. Some people sleep with the shoe on for the first few days after surgery because it gives them a sense of more security, but you do not have to keep it on unless you are walking.
You should keep your foot elevated as much as possible to minimize swelling.
If the dressing gets wet or there is a problem with it, please call the office so I can remove it myself.
Post-Operative Course
Dealing with post-operative pain will be your major concern for the first few days. Go here for information about care at home after outpatient surgery.
At the first post-operative visit I will remove the dressings, wash your foot, and take out the skin stitches.
After the skin stitches have been removed you can shower or bathe your foot, then towel it dry and put a clean sock over it. You will continue to use the post-operative shoe until 2 - 4 weeks have passed after the surgery. You can go into a regular shoe when it feels comfortable. If your surgery was on the right side you should not drive until you can wear a regular shoe. You should not sit in a hot tub until 2 weeks after surgery.
The second post-operative visit is usually at the 4 week point. At that time I will check to make sure that everything is healing satisfactorily. We will see how you are doing with your shoewear. It is possible that that will be the final visit, or I may ask you to see you one more time after an additional 4 – 6 weeks. If there are any problems or questions then we will deal with them as they present.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. With the initial swelling and pain from surgery, the motion of the toes by the surgical area may be limited. As time goes on, and when you can walk in a regular shoe, the motion generally comes back close to what it was before surgery. Generally the toes will maintain a satisfactory alignment.
Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal activities and unrestricted shoewear. You should be able to regain full strength and power in the foot. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.
Complications
Complications can occur with any surgery.
A specific risk of this surgery is the development of a stump neuroma. That occurs if there is irritation at the end of the cut nerve.
If a stump neuroma develops, you will perceive that as a pain that is similar to what you had before the surgery. If that does occur, it can be treated with shoe modifications, cortisone injections, or even further surgery to cut the nerve at a higher level. If a second surgery is required, it is done through an incision made on the bottom of the foot. After that outpatient procedure I generally keep patients on crutches for two weeks before allowing them to put weight on the foot.