Is cutting the bone to create space for the nerve a good idea?
In a paper by Bauer et al., the authors compare open surgery to remove a neuroma with an operation which involved cutting the metatarsal to effectively create space so that the nerve does not need to be removed. Interestingly, they concluded that the risk of complication and success was potentially improved by performing surgery to cut the metatarsal to provide space for the nerve.
At The London Podiatry Centre we have some reservations about this surgical approach. The study involved a two-year follow-up, and a longer review period may highlight further issues. The surgery could be considered for those patients where x-rays confirm a very narrow intermetatarsal space, but we do not believe it should be used as standard to address all forms of Morton's neuroma regardless of cause. At our Centre, we tend to avoid metatarsal osteotomies because they can be associated with increased risk of transfer metatarsalgia and other complications, even though the study did not highlight this.