Morton's neuroma excision is an operation to remove a thickened, irritated nerve between the toes (most commonly between the third and fourth toes) that causes pain, burning, and numbness in the ball of the foot.
An incision is made on the top of the foot (dorsal approach) between the affected toes. The thickened nerve (neuroma) is identified and carefully removed. The wound is closed with stitches. The procedure takes approximately 30 minutes and is usually performed as a day case.
Surgery is recommended when a Morton's neuroma causes persistent forefoot pain, burning, or numbness that has not responded to footwear modification, orthotics, and corticosteroid injection.
Wider footwear with a metatarsal pad, custom orthotics, corticosteroid injection, and activity modification. These measures are effective for many patients.
Day-case procedure. Ultrasound or MRI may have been used to confirm the diagnosis.
Relief of the burning pain and shooting sensations in approximately 80% of patients. An area of numbness between the affected toes is expected and permanent, as the nerve has been removed.
Numbness between the affected toes is expected because the nerve has been removed. Most patients find this preferable to the pain.
Forefoot swelling for several weeks.
Tenderness at the incision site.
The cut nerve end may form a painful stump neuroma in approximately 5–10% of cases.
Wound infection.
Chronic pain and swelling.
Symptoms may persist if the diagnosis was incorrect or if there are multiple neuromas.
Local anaesthetic, regional ankle block, or general anaesthesia.
A post-operative shoe is worn for two to three weeks. Stitches are removed at two weeks. Most patients return to comfortable footwear at three to four weeks. Full recovery takes six to eight weeks.
Wound check at two weeks. Review at six weeks.
Yes, there will be permanent numbness between the two affected toes. Most patients consider this a worthwhile trade-off for relief of the burning pain.
The same neuroma cannot return as it has been removed, but a painful stump neuroma may develop at the cut nerve end in a small percentage of patients.