What is Morton’s Neuroma?
Morton’s neuroma is a painful condition affecting the ball of the foot, commonly between the third and fourth toes, where a thickening of tissue forms around a nerve leading to the toes. This thickened nerve can cause intense pain, burning sensations, and a feeling of a lump in the foot. It is often caused by pressure on the nerve, which could be due to tight shoes, high heels, or abnormal foot mechanics. Although conservative treatments like changing footwear or physical therapy may provide relief, sometimes surgery is needed when these methods fail.
Surgical Treatment: Excision of Morton’s Neuroma
When nonsurgical treatments do not alleviate the symptoms, excision, or the surgical removal of the neuroma, is a common and effective option. This procedure involves removing the affected nerve to eliminate pain and other symptoms. There are two primary surgical approaches for the excision: the dorsal approach (on top of the foot) and the plantar approach (on the bottom of the foot). The goal of these surgeries is to provide relief from pain and improve the quality of life for patients.
Dorsal vs. Plantar Approach
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Dorsal Approach: This method involves an incision on the top of the foot. It allows surgeons to access the neuroma without disrupting the arch of the foot. However, this approach requires the cutting of some soft tissue and can sometimes lead to complications such as scarring or damage to other structures.
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Plantar Approach: The incision is made on the bottom of the foot, near the ball of the foot. This technique has the advantage of being less noticeable, as it avoids the weight-bearing surface of the foot. It can be more suitable for patients concerned about the cosmetic appearance of their feet after surgery. Some studies show fewer complications and better long-term satisfaction with this method, particularly when it comes to reducing the appearance-related impact.
Post-Surgery Recovery
The recovery process after excision surgery varies, but most patients experience significant pain relief within weeks of the procedure. Swelling and discomfort are common in the first few days, but with proper care, they subside. Physical therapy may be recommended to help regain strength and mobility. Some patients may experience mild numbness or altered sensation in the toes, but these symptoms often improve over time.
Long-Term Results
Long-term studies show that surgical excision of Morton’s neuroma leads to high satisfaction rates. One study reviewed 81 patients who had undergone surgery 15 years ago and found that nearly 75% reported good or excellent outcomes. Pain relief was the most significant benefit reported, although some individuals experienced mild ongoing numbness or foot sensitivity.
However, the results can vary based on factors such as the location of the neuroma and whether multiple neuromas are present. Patients with multiple neuromas or other foot conditions may experience less satisfactory outcomes.
Risks and Complications
Like any surgery, excision of Morton’s neuroma carries risks. These include:
- Infection: As with any surgical procedure, there is a small risk of infection.
- Recurrence: In some cases, the neuroma may recur, necessitating additional treatment or surgery.
- Numbness: Some patients may experience permanent numbness in the affected toes, though this is relatively rare.
- Scar Tissue Formation: Excessive scar tissue may form, causing discomfort or even further irritation to the nerves.
Conclusion
Excision of Morton’s neuroma is a highly effective treatment for those suffering from persistent foot pain caused by this condition. While there are two primary surgical approaches—dorsal and plantar—the choice of technique depends on the patient’s specific needs and the surgeon’s experience. Both approaches offer substantial relief from pain and improvement in foot function, allowing most patients to return to their daily activities with minimal discomfort. However, as with any surgery, it is essential to discuss the potential risks and benefits with a healthcare provider to make an informed decision.
Do you have more questions?
Q. What is Morton’s Neuroma?
A. Morton’s neuroma is a painful condition affecting the ball of the foot, often between the third and fourth toes, where a thickening of tissue forms around a nerve leading to the toes, causing pain, burning sensations, and a lump feeling.
Q. How is Morton’s Neuroma treated surgically?
A. Excision of Morton’s neuroma involves removing the affected nerve to alleviate pain. This can be done through a dorsal or plantar approach, with the choice depending on the patient’s needs and the surgeon’s recommendation.
Q. What is the difference between the dorsal and plantar approaches for Morton’s neuroma excision?
A. The dorsal approach involves an incision on top of the foot, while the plantar approach is on the bottom of the foot. The plantar approach is often preferred for its cosmetic benefits and lower complication rates.
Q. What is the recovery time after Morton’s neuroma excision surgery?
A. Recovery typically involves significant pain relief within weeks of the procedure, with some swelling and discomfort in the first few days. Physical therapy may be recommended to help regain strength and mobility.
Q. What are the potential risks of Morton’s neuroma excision surgery?
A. Risks include infection, recurrence of the neuroma, numbness in the affected toes, and the formation of scar tissue, though these complications are rare and manageable with proper care.
Q. How effective is Morton’s neuroma excision surgery?
A. The surgery has a high success rate, with many patients reporting significant pain relief and improvement in foot function. However, some may experience mild ongoing numbness or foot sensitivity.
Q. Can Morton’s neuroma excision be performed on both feet at the same time?
A. While it is possible to perform the procedure on both feet, it is typically done one foot at a time to ensure proper healing and reduce the risk of complications.
Q. Will I need to wear a special shoe after Morton’s neuroma excision surgery?
A. Yes, you will likely need to wear a special post-surgical shoe or boot to protect the foot and allow proper healing after the surgery.
Q. Is Morton’s neuroma excision surgery suitable for everyone with the condition?
A. Excision surgery is recommended for patients with persistent pain or symptoms despite conservative treatments like physical therapy or changes in footwear, and when the neuroma is large or causing significant issues.
Q. How soon can I return to normal activities after Morton’s neuroma excision surgery?
A. Most patients can return to normal activities within 6 to 8 weeks, though high-impact activities should be avoided until the foot has fully healed.
Q. Can Morton’s neuroma excision surgery be performed on both feet simultaneously?
A. It is generally recommended to perform the surgery on one foot at a time to allow for proper healing and reduce the risk of complications, though it is possible to treat both feet if necessary.
Q. What should I expect during the first few days after Morton’s neuroma excision surgery?
A. In the first few days, you may experience swelling, bruising, and discomfort around the incision site. Pain can usually be managed with prescribed medications, and elevating the foot can help reduce swelling.
Q. Will I have any numbness after Morton’s neuroma excision surgery?
A. Some patients may experience temporary or permanent numbness in the toes or the ball of the foot, as the surgery involves cutting the nerve. This is usually mild but can vary depending on the extent of the excision.
Q. Are there any alternatives to surgery for treating Morton’s neuroma?
A. Non-surgical treatments include wearing custom orthotics, using corticosteroid injections, physical therapy, and modifying footwear. These may provide relief for some patients, but surgery is recommended for those with severe or persistent symptoms.
Q. How long does the Morton’s neuroma excision procedure take?
A. The procedure typically takes 30 to 60 minutes, depending on the complexity of the neuroma and the surgical approach used.
Q. Can Morton’s neuroma excision be done as an outpatient procedure?
A. Yes, Morton’s neuroma excision is typically performed on an outpatient basis, meaning patients can go home the same day after the surgery, though they will need someone to drive them home.
Q. Will I need physical therapy after Morton’s neuroma excision surgery?
A. Physical therapy is usually not required after Morton’s neuroma excision, but some patients may benefit from exercises to help restore strength and flexibility in the foot, depending on their recovery progress.
Dr. Mo Athar
