Open Surgery FAQ
The majority of patients who we treat for Morton's neuroma do not undergo open surgery and are instead successfully follow treatments such as footwear change, orthotic intervention, cryosurgery and radiofrequency. However, in some cases the degree of neural thickening is too extensive and open surgery becomes appropriate. We have many years of experience in this type of surgery, and rarely encounter complications.
To date we have not had any incidence of significant complication such as stump neuroma, serious infection or thrombosis.
When a nerve is cut and removed, its end portion can form a thickened bud which then becomes hypersensitive. In other cases, excessive bleeding can cause scar tissue to form, which then joins to the end of the nerve. This causes traction on the nerve-end during walking, which can be very painful. It is challenging to diagnose these causes as both can give rise to similar symptoms. Stump neuromas can be avoided by ensuring that the neuroma is cut far enough back to avoid further irritation. Some surgeons bury the nerve into a muscle or bone, but this generally requires a plantar incision which carries its own further risks.
This has been debated by Podiatric surgeons for some time. At our Centre, we favour an incision at the top of the foot. We have seen many examples of patients where an incision at the bottom of their foot (plantar incision) has left a painful thickened scar, which can be more troublesome that the original neuroma. However, a plantar incision may well be required in revision surgery on order to reach the nerve.
Yes, most surgeries at our Centre are done under local anaesthetic (where you remain awake) as this carries less risk than general anaesthetic. Local anaesthetic injections are generally very well tolerated, and patients can listen to music during the procedure.
Generally, the operation lasts no more than about 40 minutes.
Patients are required to have complete rest (toilet duties only) for the first week. During the second week it is possible to "potter" around the house, but we would not recommend going outside. After two weeks, the sutures are removed and you can return to work. We would recommend waiting at least two months before returning to sport. The dressing has to be kept dry until the sutures are removed.
These are summarised in our foot surgery booklet. They include infection, stump neuroma and thrombosis.