How is the Surgery Performed?

The traditional approach to surgery for Morton’s Neuroma is to remove the nerve. The nerve is normally swollen as a result of pressure from adjacent bones or from inflammation around the nerve.

A cut is made on the top of the foot. The ligament between the bones is cut and the nerve is identified. The nerve is separated from the branches going into the toes and cut much higher up the foot.

The nerve is allowed to fall back so that it cannot be irritated.

As the nerve has been cut, there is a numb patch in between the two toes and under the foot itself. This is permanent.

One risk of surgery is that the raw end of the cut nerve can be very sensitive. Most patients are better and have a lot less pain after surgery. Some patients find that the pain is just as bad as it was prior to the operation and in a very few, it is worse. This occurs especially in the space between the third and fourth toe, where there are lots of nerve branches. If there is recurrence, then a second operation may be performed to cut the nerve back further.

One way to try to avoid cutting the nerve is by performing bony surgery around the nerve. This aims to relieve pressure on the nerve by decreasing the amount of load on the surrounding metatarsal bones. If this is unsuccessful, then the nerve may still need to be removed.

Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

swollen nerve

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