Morton's neuroma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Surgery is the last resort in the treatment of morton's neuroma. In some cases, surgery may be needed to remove the thickened tissue/affected nerve in order to help release the pressure on the affected nerve, relieve the pain and improve foot function. Few complications after surgery are possible and include permanent nonpainful numbness if a portion of the affected nerve is removed, risk of postoperative infection around the toes, incisional soreness, scarring, and recurring stump neuromas. Morton's neuroma can be removed surgically either via dorsal or plantar approach, with each approach having its own merits and demerits. Depending upon each individual case, different surgical procedures that can be used for the treatment of morton's neuroma include neurectomy, cryogenic surgery/neuroablation, and decompression surgery.

Surgery

• Surgery is the last resort in the treatment of morton's neuroma and is advised when:
  • Other therapies have failed
  • Symptoms persist after 9 to 12 months
• In some cases, surgery may be needed to remove the thickened tissue/affected nerve in order to help:
  • Release the pressure on the affected nerve by widening the space through which the affected nerve travels
  • Relieve the pain
  • Improve foot function

Complications after the surgery

• If a portion of the affected nerve is removed during the surgery, permanent numbness occurs between the toes, but it's not painful
• There is a small risk of infection around the toes after surgery
• Incisional soreness
• Scarring
• Recurring stump neuromas

Surgical Approaches

Following two surgical approaches can be used:

Different surgical approaches

Type of surgical approach	Details
Dorsal approach	Surgeon makes an incision on the top of the foot As the stitches are not on the weight-bearing side of the foot, this approach allows the patient to walk soon after surgery
Plantar approach	Surgeon makes an incision on the sole of the foot During recovery, most patients will need to use crutches for about 3 weeks Resulting scar might make walking uncomfortable Benefits of plantar approach includes: It is easy to remove neuroma by this approach Neuroma can be removed without cutting any structures

Surgical Procedures

Different surgical options for the treatment of Morton's neuroma

Surgical procedure	Details of the procedure
Neurectomy	It involves the removal of a part of the nerve tissue
Cryogenic surgery/Cryogenic neuroablation	It kills the nerves and the myelin sheath covering them by using extremely cold temperatures Low chances of recurrence
Decompression surgery	It relieves the pressure on the nerve by cutting the ligaments and other structures around the nerve

References

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