Benefits and risks
We will only consider open surgery with a dorsal approach (incision on the top of the foot) for the small number of patients who have tried other, less invasive treatments with no success. Whilst we do have a success rate of over 90% for this procedure, the longer recovery period and increased risk of complication, including stump neuroma, means it should remain a last resort option.
The risks of open surgery include:
Using long-acting, ultrasound-guided local anaesthetic means that most patients experience minimal pain after their surgery. We provide appropriate pain medication and our audits show that patients rarely experience a pain level greater than five out of ten the day after surgery.
Open surgery will result in greater swelling than minimally-invasive procedures such as cryosurgery and ablative radiofrequency. The degree of swelling can be kept to a minimum by carefully following our post-operative advice regime. This includes keeping the foot elevated as much as possible for the first week after surgery and minimising physical activity as much as possible. Walking should be limited to toilet duties for the first week after surgery.
Blood clots (DVT and pulmonary embolism):
The formation of a post-operation blood clot can be serious or even fatal. In the thousands of operations we have performed, blood clots have been extremely rare. In the less than a handful of cases where patients developed a clot in their leg, all made a full recovery. For patients who are more susceptible to developing blood clots, we will take appropriate steps (such as organising blood thinning medication) as required. None of our patients who have undergone neuroma surgery have developed a blood clot.
The Morton’s Neuroma Centre has a very low infection rate. To date (November 2018) we have not encountered any serious infections that can be acquired in hospitals such as MRSA and C Diff. Similarly, none of our patients have experienced any serious infections from undergoing neuroma surgery.
A neuroma is unlikely to recur once it has been removed. Patients who experience success but eventual recurrence are more likely to be suffering from a stump neuroma or a painful internal or external scar.
This is specifically discussed in the stump neuroma section of this web site.
Painful scar formation:
Some patients experience excessive scarring and this can result in adhesions and pain where surgery took place. Scarring may be internal or external and can be managed in a variety of ways. Steroid injections often help to break up scar tissue, and silicone anti-scar dressings are very effective in treating topical scars.
Complex regional pain syndrome: This is a relatively rare and poorly understood condition characterised by chronic pain and hypersensitivity in the area that was operated on. The whole foot, and even the leg, can be affected. We have encountered one mild case of complex pain syndrome in relation to the treatment of neuromas in which the patient made a good recovery.