Neuroma

What is a Neuroma?

A neuroma is a painful trapped and swollen nerve found in the forefoot, often causing numbness or sharpness of the toes with patients reporting a burning or tingling sensation. Conservative and surgical treatment options are available and around 80% of patients are managed without surgery.

Morton’s Neuroma

The condition was first described by an English Podiatrist in 1845 but named by an American Surgeon in 1876. The neuroma is a swelling and thickening of the nerve under your foot just before the toe web-space. When you walk the nerve is compressed and causes pain which usually is felt as a burning sensation which often radiates to the toes.

Conservative treatments for this condition often work well and if needed the recognised surgical treatment for Morton’s neuroma is remove the swollen nerve. This will lead to some numbness of the adjacent toes but should not affect your mobility.

What Causes a Neuroma?

Morton’s neuroma is a fairly common condition, especially in females and it typically occurs when one of the nerves between the toe bones becomes irritated, causing it to become thicker.

The condition has been linked to:

wearing tight, pointy or high-heeled shoes
being active and playing sport (particularly running or sports that involve running and placing pressure on the feet, such as racquet sports)
other foot issues and deformities such as flat feet, bunions or hammer toes can increase the risk of neuroma

What are the Treatment Options for a Neuroma?

There are conservative and surgical solutions available to treat neuroma.

Non-Surgical Treatment

Non-surgical treatments (such as painkillers, custom orthoses and pain-relieving injections) can help ease the pain and discomfort caused by a neuroma and can often be successful. However, where there is severe discomfort surgical intervention is typically recommended when simple treatment has not worked.

Surgical Treatment

Surgical treatment is recommended if you’re suffering from severe pain from Morton’s Neuroma.

What Happens During Surgery?

The operation will take about 20 minutes and usually involves making an incision on top of the foot via which the nerve is removed.

Occasionally, this procedure is carried out via an incision under your foot and if this does happen you will need crutches after surgery.

Are there risks or side-effects following surgery to remove Morton’s Neuroma?

As with any medical procedure there are risks which Mr. Kannegieter will always thoroughly explain to you prior to your treatment, so you can be informed every step of the way.

The main risks following surgery are:

Pain
Swelling
Infection
Deep vein thrombosis
Complex Regional Pain Syndrome (CRPS)

Specific complications of Morton’s Neuroma Surgery:

In a small percentage of patients, the operation is unsuccessful and can lead to a painful nerve ending. This is a ‘Stump Neuroma’ and is uncommon. It can occur if you are too active in the post-operative period. Reports differ but it is believed to occur in about 5-20% of patients. It can be treated by steroid injection and if severe, further surgery.
Further (revision) surgery after neuroma surgery carries a significant risk of scarring and continued discomfort.
The sides of the toes supplied by the damaged nerves will be permanently numb. Most patients are aware of this when the toes are touched but not usually when walking. It rarely causes concern.
Your foot may develop scar tissue which in some people can cause a bruise like discomfort around the operation site and this may last for many months. It usually improves in time.
You may develop pain in adjacent parts of the foot after surgery which were not originally apparent at the time of surgery.

What Happens After Surgery?

After the operation you will be taken back to the ward and given a drink and something to eat. You will be advised on taking painkillers and given a post-operative boot to wear. Once ready you will be discharged from the day surgery unit.

You should not drive after foot surgery and should be accompanied home by a responsible adult.

You will be advised of your follow up appointment date, either on the day or by letter in the post.