Surgical Treatment of Morton's Neuroma: Pressure Relief or Excision
Fact Sheet Excision or Decompression of Mortons neuroma
- Inpatient treatment: 2 days
- Outpatient rehabilitation treatment required: 2 weeks
- Earliest flight home: 3 days after surgery
- Recommended flight home: 5 days after surgery
- Time before shower: 7 days after surgery
- Recommended time off work: 5 days
- Time before removal of sutures: 10 days
- Time before driving a car: 5 days
Morton's neuroma is a painful inflammation of a nerve in the frontal part of the foot. Morton's Neuroma is often is often associated with splay foot (incorrect pressure on the foot which triggers further foot problems). Typical symptoms of Morton's Neuroma are numbness or tingling of the foot. Many patients experience immediate pain relief on removing their shoes. The most common location of pain caused by Morton's neuroma is the ball of the foot (where the toes join the rest of the foot) and in the space between the third and fourth toes.
How can I be sure that the pain in my forefoot is due to Morton’s neuroma?
Morton’s neuroma causes pressure-related pain in the metatarsus (also referred to as the forefoot or the metatarsal bones). Those who suffer from Morton’s neuroma frequently experience foot pain while walking in tight-fitting shoes.
In addition to the toe pain, Morton’s Neuroma sufferers may report a tingling sensation or numbness in the neighboring toes, typically on the bottom of the forefoot between the third and fourth toes or between the second and third toes. The pain may be described as a burning or pricking sensation.
However it is important to realise that patients with Morton's neuroma do not always feel numbness or tingling in the area of the affected toes. Indeed, in some cases, patients experience no more than a certain pressure-related pain.
For this reason, it is essential to first determine the location of the nerve damage in the forefoot. Before considering surgery, it is also essential to determine whether the condition is accompanied by excess looseness in the metatarsophalangeal joints.
The most typical sign of the presence of Morton's neuroma is if the patient needs to remove their shoes straight after walking or running in order to alleviate pain.
These Symptomes are not Compatible with Morton´s Neuroma
Alternative Causes of Pain in The Forefoot
- Inflammation in any of the joints between the metatarsal bones (bones of the forefoot) and the proximal phalanges (bones at the base of the toe)
- Nerve damage
- Stress fractures in any of the metatarsal bones
- Soft-tissue changes, including scars, warts and tumors
- Improper weight distribution as in the case of pronounced splayfoot
Pain at rest or pain at the start of walking are not typically associated with the condition. They are more likely to represent a basis for ruling out Morton’s neuroma.
The taking off of shoes will tend to alleviate the pain. Improvement is also seen when wider shoes are worn. In addition to Morton’s neuroma, doctors have identified many possible causes of forefoot pain.
What causes Morton’s neuroma?
Morton’s neuroma is often associated with splayfoot. Splayfoot happens as a result of a change in the distribution of weight in the forefoot, this is due to the loss of the transverse arch and leads to irritation in the nerve under the ball of the foot, at the point where it branches out to the toes.
Prolonged irritation is thought to damage the nerve and lead to the development of Morton’s neuroma.
While the term neuroma refers to a benign nerve growth or tumor, Morton’s neuroma is thought to involve nerve irritation that leads to distension, but not to benign tumor formation.
Which toes are most commonly affected?
Morton’s neuroma occurs most frequently between the third and fourth toes, but may also occur between the second and third toes.
Is the condition more prevalent in certain groups of individuals?
Although Morton’s neuroma occurs more frequently in adults, it has been observed in people of all ages. Women are four times more likely to suffer from the disorder than men.
What examinations are used to reliably diagnose the condition?
Conservative Treatment for Morton’s Neuroma
- Shoe inserts to support the transverse arch
- Phonophoresis (use of ultrasound to aid absorption of medication applied to the skin)
- Lontophoresis (technique of using a small electric charge to deliver medicine through the skin
- Local cold applications (ice massage)
- Local homeopathic injections
- Local cortisone injections
Surgical Options for Morton Neuroma
- Removal of the affected nerve
- Osteotomy to correct splayfoot deformity
A thorough patient interview and a comprehensive physical examination provide an initial basis for a reliable diagnosis. Various procedures such as x-rays and ultrasound may then be carried out to confirm or discount any initial findings.
Magnetic resonance imaging (MRI) is not a particularly effective way of confirming the diagnosis in this case. Injections of certain painkillers can confirm the diagnosis of Morton’s neuroma if they give temporary pain relief.
What therapeutic options are available for Morton’s neuroma?
There is widespread agreement in the medical community that the first attempt to treat Morton’s neuroma should be by using conservative (non-surgical) treatment.
The first step in treating Morton's neuroma is to reduce the weight on the forefoot in order to release pressure on the compressed nerve.
A podiatrist is likely to recommend changing to a properly fitting shoe without a heel and with enough room in the toe area to keep the toes from being closely squashed together. The shoe must also be able to support the arch of the foot and the heel, and provide cushioning for the forefoot. Sometimes orthotic shoe inserts are needed to further relieve the stress on the forefoot.
Cortisone injections may sometimes be advised but these will only deliver temporary pain relief and not solve the problem in the long term.
Surgery for Mortons Neuroma
Surgery for Morton's neuroma represents an option if more conservative forms of treatment do not solve the problem.
Surgery: Excision of Morton´s Neuroma
Sometimes surgery is required for sufferers of Mortons Neuroma in order to release the pressure on the nerve that is being compressed or pinched between the bones of the toes and the ligament that holds them together.
First the surgeon makes a small incision (cut) just below the painful toes. There are then two options for relieving the pressure.
Option 1. The deep transverse ligament is cut, this relieves the pinching on the nerve, but leaves the nerve in one piece and as a result there is still complete feeling in the toes.
Option 2. The part of the nerve with the neuroma is cut and removed (the ligament may also be cut as in Option 1). As the nerve supplies feeling to the toes, feeling may be permanently lost in the third and fourth toes.
The incision is closed with stitches and the foot is bandaged. A post-operative shoe is worn until the stitches are removed 10-14 days after the operation. Most people are able to wear a normal walking shoe comfortably after 3 weeks.