Surgery to Treat Morton's Neuroma
Conservative treatment does not work for most patients with Morton's neuroma and minor surgery usually is necessary. Two surgical procedures are available.
The dorsal approach involves making an incision on the top of the foot. This approach permits the patient to walk soon after surgery because the stitches are not on the weight-bearing side of the foot. In this procedure, the podiatrist maneuvers the instruments carefully through many structures and cuts the deep transverse metatarsal ligament, which typically causes most of the nerve compression. This procedure can lead to instability in the forefoot that may require attention in the future.
The second procedure involves a plantar approach, in which the incision is made on the sole of the foot. The patient must use crutches for about 3 weeks and the scar that forms can make walking uncomfortable. The advantage of the plantar approach is that the neuroma can be reached easily and resected without cutting any structures.
Morton's Neuroma Surgical Complications
The surgical area contains very small blood vessels, nerves, and muscles and complications can occur. Once the neuroma is removed, the empty space may fill with blood, resulting in a painful hematoma. There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.
Recurrence is another possibility. The stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.