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Morton's Neuroma

This leaflet aims to answer your questions about having surgery for Morton’s neuroma under the care of Mr Rajiv Limaye. It explains the benefits, risks and alternatives, as well as what you can expect when you come to hospital.

What is Morton’s Neuroma surgery?

Morton’s neuroma is a painful swelling or irritation of the nerve that runs between the long bones of the foot (metatarsals). When this nerve becomes enlarged it causes pain in the ball of the foot that radiates to the toes and some time presents an tingling and numbness of toes. It is most common between the third and fourth toes but can afftect other toe spaces as well.

The surgery aims to remove the neuroma to relieve the pain.

What happens during Morton’s Neuroma surgery?

Morton’s neuroma surgery can be done as a day surgery procedure unless you have other medical problems that mean you may need to stay in hospital overnight. The surgery is performed under general anesthetic. A cut is made over the top of the foot, at the base of the affected toes. The operation involves removing the part of the nerve that is causing the pain and discomfort. The foot and ankle are then bandaged.

Why should I have Morton’s Neuroma surgery?

Non-surgical treatment methods may have been tried first. These include appropriate wide and soft shoes or shoe inserts to cushion the sole of the foot. Sometimes an injection helps the symptoms. If these measures all fail, then you may wish to consider surgery.

What are the risks?

In general, the risks of any operation relate to the anesthesia and the surgical procedure itself. In most cases you will have a general anesthetic. You will be able to discuss this with the anesthetist before surgery and he/she will identify the best method for your individual case.

Risks include

  • Infection - approximately 1% risk in our unit
  • Blood clots (thrombosis) – The risk is very low. So do not 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 or persistent pain (10-20%) - occasionally symptoms will be improved but remain present to a small degree.

Are there any alternatives?

Simple non-surgical measures, as detailed above, should be tried before undergoing surgery.

You should make arrangements to be collected from the hospital. Most of the time your operation will be done as a day case. You will need some time off work after the surgery. This will be at least 2-4 weeks but maybe longer if you have a manual job. Mr Limaye will discuss this with you. We advise you speak to your employer before surgery to make plans.

Giving consent (permission):

Mr Limaye needs to ask your permission to perform Neuroma/Bursa surgery. You will be asked to sign a consent form that says you have agreed to the treatment and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell him or the staff caring for you.

Remember, it is your decision. You can change your mind at any time, even if you have signed the consent form. Let staff know immediately if you change your mind. Your wishes will be respected at all times. If you would like to read our consent policy, please tell a member of staff.

Will I feel any pain?

There will be some pain after the surgery. While you are asleep local anesthetic may be injected into your foot to reduce the pain after the operation even if you go to sleep for the surgery. You will be given medicines to take home to control the pain. The nurse will go through the medicines with you, including how often and when to take them. There will be a combination of strong and weak pain killers.

If your pain does not settle, you can either be reviewed in your scheduled outpatient appointment, contact Mr Limaye or the ward or you should seek further advice and management from your GP.

The Day of the Surgery:

Mr Limaye will see you before and after your operation. The anesthetist will also see you before your operation either on the ward if you are early on the list or in the theatre suite, any queries about the anesthesia are best discussed with him/her directly on the day.

Waiting for your operation:

Please note that you may not be the first patient on the operating list and therefore have a variable amount of time during which you will be waiting to go to theatre; how long will depend in your place on the list. If you are the last patient to be scheduled for surgery, it may be up to three or four hours; you should therefore come prepared for a wait. Some reading material is provided by the day care unit but we appreciate a wait of several hours can be tedious; as such you may wish to bring a book, some work or other material to keep yourself occupied. Or just relax, unwind and enjoy a good movie.

After your operation, prior to discharge:

Your foot will be heavily bandaged to protect it and reduce the swelling. The gauze bandage which is applied in theatre in a sterile environment will stay on for 2 weeks. There will be no plaster cast. The physiotherapist will issue you with crutches and a special surgical sandal to wear. If you already have either of these, please bring them with you. The crutches are not essential, but as the foot is sore when weight bearing you may find it helpful to use them.

You will be given medications to take home to control the pain. These will be a combination of strong and weak painkillers. A nurse will go through the medications with you, confirming how often and when to take them.

When you feel comfortable and ready you will be allowed to go home. You should have made arrangements to be picked up from the hospital and have someone staying with you at least overnight if you are a day case.

As a day case patient, you can normally go home about 3-5 hours following surgery. As an overnight, patient you will be discharged the next day.

What happens after Morton’s Neuroma surgery?

The day of your surgery:

When you have recovered from the anesthetic, normally you can get up and walk freely in a special sandal that will help protect the operation site. If it is a "re-do" surgery, then your walking may be limited on the same day as surgery. Your foot and ankle will be securely bandaged to protect it and to reduce the swelling. The gauze bandage which is applied in the operating theatre will stay on for two weeks. There will not be a plaster cast. You must keep your foot elevated. Most patients can go home on the same day as the surgery.

What do I need to do after I go home?

This is a general guide only. Patients will progress and recover from their surgery at different rates. If your surgeon Mr Limaye gives you different advice, then you should follow that.

First two weeks after surgery:

The local anesthetic in the joint will start to wear off, so you will need to start taking painkillers.

You should keep the foot elevated when not walking or exercising for the first week after the operation. Whenever the foot is put down, it will swell and become sore. It is normal to see mild bruising and some dry blood on the foot. By the end of this week the post-operative pain will have significantly reduced.

Continue to elevate the foot as much as possible. You may walk short distances within your home or to a car from this week, ensuring you are wearing the special sandal. In week two you can start working from home and possibly return to work but you must try and keep the foot elevated. Depending on the nature of your employment, you may be signed off from working for longer.

You will be seen approximately two weeks (10 – 17 days) after your operation in the outpatient clinic. This appointment will be made for you by Mr Limaye’s secretaries. At this time the wounds will be checked, and any stitches removed. He will advise you at this appointment regarding your return to work.

You will first see the team nurse and then Mr Limaye. At this appointment, the bulky dressings and stitches are removed. Steri-strips, which are paper dressings may be applied. You will leave with the same surgical shoe on or a loose trainer if you have one. If you have been keeping the leg elevated, you may find some bruising in the arch of the foot. Do not worry this is normal.

After two weeks:

You can start driving after two weeks. The Drivers Vehicle Licensing Agency (DVLA) regards it as your responsibility to judge when you can safely control a car. You should contact your doctor or the DVLA and your insurance company if you are concerned about this.

You should not drive, unless your surgery was on your left foot and you have an automatic car. If surgery was on your right foot or you have a manual car, it will be 3 - 4 weeks before you can drive. Motor insurance companies vary in their policies. It is best to discuss your circumstances with your insurance company to be sure that you are covered. You can usually return to work after 2 weeks.

You should remove all the remaining wound dressings at home, by soaking the dressings off in the shower. You should apply skin emollient around the healing wound. Once the wound is completely healed, you should apply the moisturizer over the wound as well.

You may go swimming if the wound is dry and healed.

At this stage, your foot will still be swollen. Do not expect to fit into your normal shoes. You may start wearing a pair of wider, looser fitting shoes. A good option includes trainers, with loosened laces.

Low impact exercise, such as exercise bike and cross trainer can be started. You may now drive a manual vehicle in addition to an automatic. However, motor insurance companies vary in their policies please check with your insurer first.

It may take 6 weeks to return to your normal sporting activity level. You can start gentle exercises and activities earlier and gradually increase your activity level with time. You should speak to Mr Limaye about this if you are uncertain.

For short haul flights you will be able to fly after 2 weeks. For long haul it is 6 weeks. We do make exceptions if your home is abroad.

Your foot may continue to be swollen for up to 3 months following this surgery.

What should I do if I have a problem?

If you experience any of the following symptoms, please contact Mr Limaye, the ward or your GP:

  • Increasing pain
  • Increasing redness, swelling or oozing around the wound site
  • Fever (temperature higher than 38°C).
  • suspect you have DVT (deep vein thrombosis) - symptoms include pain and/or burning in the back of your lower leg. You may also feel unwell and have a temperature.

If, at any time in your post-operative recovery, there is any sign whatsoever of infection, either suspected by you or diagnosed by your GP, please contact your consultant’s secretary at the hospital.