A Morton’s neuroma is in essence a scarred (common plantar digital) nerve. It can cause a multitude of symptoms but typically intermittent forefoot pain, fullness or tingling numbness. It is NOT a dangerous condition and therefore treatment is determined by the extent of the symptoms it gives. One may simply tolerate it or use any of a number of non-operative techniques. These include: change of shoe wear so that there is more room, use of insoles or inserts which aim to slightly lift and separate the metatarsal heads and reduce pressure here. During episodes of pain injection around the nerve with steroid can settle down symptoms for a month and sometimes longer.
Surgery involves excision of this nerve which results in permanent numbness of the web space involved (the sides of two adjacent toes). In the majority of cases this resolves the problem.
Placing the incision on dorsum of the foot is important in that it prevents the possibility of a painful scar on the weight bearing surface of the foot.
The nerve is approached through the top (dorsum) of the foot. Two adjacent metatarsals are separated and the ligament between their heads is divided. The nerve lies immediately under this ligament. The nerve is then resected well proximal in the web so that when it heals its’ scarred end is away from the weight bearing portion of the foot.
The combination of local anaesthesia and a dorsal approach allows the patient to walk full weight bearing in a solid (wooden) soled post-operative sandals immediately after the operation. Most cases are performed as a day case procedure.
This surgery typically resolves symptoms due to the neuroma but it may leave some discomfort. Clearly not all cases are improved with operation and a few are made worse. Potential problems with all surgery include infection, recurrence of neuroma, as well as anaesthetic and drug reactions. Placing the incision on dorsum of the foot is important in that it prevents the possibility of a painful scar on the weight bearing surface of the foot.