Excision of Mortons neuroma


What is excision of Mortons neuroma?

The operation is designed to get rid of the symptoms of pain, burning and tingling in the toes.

It involves making an incision over the top of the foot in between the toes to gain access to the nerve which is between the toe bones. The swollen part of the nerve is then cut out and the wound is closed.


Type of procedure

This is a day case procedure and same day discharge is usual.

Type of Anaesthesia?

The operation will be undertaken under a light general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes about 10 to 15 minutes.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with minimal risks of:

Infection:

As the nerve is removed, there will be numbness to the affected toes in about 50% of the cases.

Numbness:

There may be accidental damage to a small branch of the nerve which supplies sensation to the top of the foot. This may result in numbness or pins and needles. Risk is approximately 5%.

Recurrence:

The nerve can grow back and this could cause symptoms to recur. Overall risk of this occurring is about 20% after neuroma surgery.


Recovery from Surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot. The physiotherapists will make sure that you are safe on your feet before discharge. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 - 7

  • Ensure that you keep your foot elevated on pillows to help reduce swelling.
  • Foot wrapped in bulky bandage and surgical stiff sole  shoe.
  • Allowed to heel walk in a stiff sole shoe
  • Ice, Elevate leg and take pain medication.
  • Expect numbness in foot 12-24 hours then moderate pain.
  • Bloody drainage through bandage expected.
  • Do not change bandage.

Day 14

  • You will have a follow up visit in clinic.
  • Your wound will be inspected. You will have absorbable sutures so they will not need to be removed.
  • You can walk normally in your own shoes by this time.

6 weeks

  • Final follow up clinic visit prior to discharge


Post operative clinic visit schedule

  • 2 weeks after surgery - wound check and advice regarding basic hygiene
  • 6 weeks after surgery - final follow up clinical examination and discharge


When can I begin to walk?

You are allowed to walk in a stiff sole surgical shoe on the day of surgery. However you must ensure that you use this shoe at all times for the first 2 weeks after your operation.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is within 2 weeks after surgery.

Click here to read the guidance from the DVLA on driving after surgery.

When can I get back to work?

Returning to work is very much dependent on the specific type of job and individual.
As a rule of thumb -

• Office based sedentary work - 1-2 weeks
• Manual labour - 3 weeks

When can I get back to sport?

It depends on the kind of exercise, but as a general rule of thumb you can get back to sports like golf 4-6 weeks time.

 
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