Excision of Morton’s Neuroma
This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes 20 minutes. It is successful in 90% of cases.
Technique
A 2 cm incision is made on the top of the foot between two toes (occasionally it is necessary to approach the nerve through a cut in the sole of the foot) and the affected nerve is removed.
The skin is stitched, and a wool and crepe bandage applied.
Risks
All surgery carries potential risks. The risks are minimized by having the surgery meticulously performed by an expert in foot and ankle surgery. Risks include
- Infection - approximately 1% risk in our unit
- Blood clots (thrombosis) – The risk is very low. So donot require any special medications unless you are high risk for blood clots.
- Numbness – between the toes after this surgery is common. Usually improves with time
- Pain and swelling-This can occur after any foot and ankle surgery. You have to keep the limb elevated for 48 hours to avoid swelling and you will be given pain killers.
- Stiffness – This is uncommon after this procedure. This improves over time and helped by physiotherapy
- Scar sensitivity - can be improved with scar massage with emollients.
- Incomplete improvement - occasionally symptoms will be improved but remain present to a small degree
Discharge advice following Excision of a Morton’s Neuroma
Dressings
Your foot has been dressed in a wool and crepe bandage. This dressing should not be changed until you are seen at your first follow- up appointment after 2 weeks. The dressing must be kept clean and dry.
Elevation
It is very important that you rest as much as possible and keep your foot elevated for the first 48 hours after surgery. Try to avoid letting it hang down when sitting as this will lead to swelling and pain. This is most apparent within the first 2 weeks but swelling may occur for up to 6 months after surgery, especially after sitting or standing for long periods. In bed, put the foot on a pillow.
Analgesia
You will receive pain medication on discharge. Pain is often due to swelling, and this is eased by rest and elevation of the foot.
Walking
A special shoe has been supplied for you to wear over your dressings which should A special shoe has been supplied for you wear over your dressings which should be worn during the day. A physiotherapist will show you how to use crutches and apply the shoe. It is necessary for you to initially walk by taking the weight on your heel so that you don’t put pressure on the toes. It is not necessary to wear this shoe in bed.
Follow-up
You will be seen after approximately 2 weeks when the dressings and stitches will be removed. The foot is often slightly swollen at this stage and so a comfortable pair of loose-fitting shoes or trainers will need to be worn and should be brought to the clinic. You will then be reviewed again at 6 weeks.
Driving and work
You should not drive a manual car for 2 weeks following surgery. After this you should start gradually to see if you are comfortable. It normally takes a few days to feel confident. If you have an automatic car and have only had the left foot operated upon then you may drive after 5-7 days.
If you have an office-based job, then you should be able to return after 2 weeks. If you have a more physical job, then it may take 4 weeks.
Recovery
It often takes 3 months for all swelling to resolve following surgery and so minor swelling late in the day is not unusual and should not be a cause for concern.