Neuroma Excision

When conservative treatments such as orthotics, physical therapy, and injections fail to provide relief, surgical excision of the neuroma may be necessary. One effective surgical approach is the excision of Morton’s neuroma using a plantar incision. This blog will discuss the procedure, potential recurrence, and post-operative recovery.

Understanding Morton’s Neuroma

Morton’s neuroma typically affects the nerve between the third and fourth toes, although it can occur between other toes. It is more common in women and is often associated with wearing high-heeled or tight shoes that put pressure on the ball of the foot.

The Procedure: Morton’s Neuroma Excision Using a Plantar Incision

Surgical excision of Morton’s neuroma aims to remove the inflamed nerve tissue to relieve pain and discomfort. The plantar incision approach, made on the bottom of the foot, provides direct access to the neuroma.

Step-by-Step Procedure

1. Preoperative Planning: Detailed clinical evaluation and imaging studies (such as ultrasound or MRI) help confirm the diagnosis and plan the surgical approach.

2. Anesthesia: The procedure is performed under general anesthesia, depending on the patient’s preference and medical condition.

3. Incision: A small incision is made on the plantar (bottom) side of the foot, directly over the affected area. This approach allows for direct access to the neuroma and minimizes disruption to surrounding tissues.

4. Neuroma Excision: We carefully isolate the thickened nerve tissue with its branches and removes it. The surrounding structures are preserved to the greatest extent possible.

5. Closure: The incision is closed with sutures, and a sterile dressing is applied. A protective boot or post-operative shoe is often used to support the foot.

Possible Recurrence and Statistics

While Morton’s neuroma excision is generally successful, there is a possibility of recurrence or the development of a stump neuroma (regrowth of the nerve). Studies suggest that recurrence rates range from 10% to 20%, depending on various factors such as the surgical technique used and the patient's individual characteristics.

Post-Operative Recovery

Recovery from Morton’s neuroma excision involves several stages to ensure optimal healing and a return to normal activities.

1. Immediate Post-Operative Period (0-2 Weeks):

   • The patient is non-weight bearing on the affected foot for the first two weeks.
   • Crutches, a knee scooter, or a walker may be used to aid mobility.
   • Pain and swelling are managed with prescribed medications, ice, and elevation.

2. Transition Period (2-6 Weeks):

   • After the initial two weeks, patients typically transition to weight-bearing as tolerated.
   • A gradual return to regular shoes is encouraged, starting with supportive, comfortable footwear.
   • Physical therapy may be recommended to restore strength, flexibility, and gait.

3. Full Recovery (6+ Weeks):

   • Most patients can resume normal activities, including low-impact exercises, within 6 to 8 weeks.
   • High-impact activities, such as running and jumping, should be avoided until the foot is fully healed and cleared by the surgeon.

Conclusion

Morton’s neuroma excision using a plantar incision is an effective surgical treatment for chronic foot pain caused by this condition. Although there is a risk of recurrence and scar tissue on the bottom of the foot, the majority of patients experience significant relief and can return to their normal activities after a structured recovery period.

If you are suffering from persistent pain in the ball of your foot and conservative treatments have not provided relief, schedule an appointment with us for consultation and treatment.