Recurrent Morton’s Neuroma – Why?
A fair percentage of Morton’s neuroma surgery patients develop either recurrent neuroma or similar symptoms often due to neuroma stump formation. It is estimated that as high as 30% of Morton’s neuroma surgery patients end up with post surgical pain. It is important to follow all post-surgical protocols in order to lessen the risk of complications.
Post surgical recovery generally takes 3 – 4 months due to collagen remodeling and the natural scarring process.
If you have pain after Morton’s neuroma surgery, it is very important to identify the correct cause of your pain. The most common cause of post Morton’s neuroma surgery pain is the formation of a recurrent neuroma or stump neuroma. If you develop pain after Morton’s surgery, you should see an experienced clinician as soon as possible since delaying treatment deceases the likelihood that conservative options would help.
What are common causes of pain mimicking Morton Neuroma after surgical intervention?
Below are some common causes of pain in the intermetatarsal space (especially third) after surgical intervention:
- Continued irritation or inflammation of severed end of the nerve
- Delayed healing of nerve
- Extensive/ abnormal scarring of severed ends
- Entrapment of resected nerve
- Adhesion of severed end of the nerve to one of the metatarsal heads
What are some risk factors and classic symptoms of Recurrent Morton Neuroma?
The nature of the surgical procedure and the expertise of surgeon plays a vital role in the likelihood of recurrent Morton neuroma formation. Typically, the symptoms present between 3 to 12 weeks after surgery, but may be delayed by months or even years.
Classic symptoms of recurrent Morton neuroma are:
- Pain at the site of stump formation (that is conventionally 1.5 cm proximal to the involved web-space)
- Formation of a palpable lump or swelling that is suggestive of inflammatory swelling
- Changes in the sensation; depending upon the involvement of nerve (could be hyperesthesia or hypoesthesia)
- Aggravation of pain and local discomfort with excessive ambulation or walking
What should you do if you develop recurrent Morton neuroma?
Typically, conservative management is generally inadequate at achieving pain relief. Most patients report no improvement in symptoms with the use of ordinary over-the-counter anti-inflammatory drugs. However, you may achieve some improvement in symptoms with certain lifestyle modifications; such as:
- Use of low heel shoes;
- Wearing comfortable, right-sized shoes with wide toe boxes;
- Use of orthotics or/and accommodative insoles; and,
- Physical therapy (even combined with hydrotherapy)
If your Morton’s neuroma persists, you can also employ other treatment options like ultrasound guided ablation procedures. These can be very successful, especially if done under ultrasound guidance and after a diagnostic local anesthetic injection.
About 10% of patients undergo a repeat surgery to fix the symptoms of recurrent Morton’s neuroma. Unfortunately, the success rate in most revision surgeries is quite low.
Patients should avoid prolonged immobilization which can delay the healing process and adhesion formation. Soon after surgery, you should exercise to enhance your range of motion.
- Southerland, J. T., Boberg, J. S., Downey, M. S., Nakra, A., & Rabjohn, L. V. (2012). McGlamry’s comprehensive textbook of foot and ankle surgery. Lippincott Williams & Wilkins.
- Malay, D. S. RECURRENT INTERMETATARSAT NEUROMA.
- Richardson, D. R., & Dean, E. M. (2014). The Recurrent Morton Neuroma: What Now?. Foot and ankle clinics, 19(3), 437-449.
- Kundert, H. P., Plaass, C., Stukenborg-Colsman, C., & Waizy, H. (2015). Excision of Morton’s Neuroma Using a Longitudinal Plantar Approach A Midterm Follow-up Study. Foot & Ankle Specialist, 1938640015599032.
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.