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.
