When Should I Have Surgery For Morton’s Neuroma?
Morton’s neuroma (also referred to as metatarsalgia) is a chronic and painful condition of forefoot resulting in varying degrees of disability and compromised quality of life.
Most patients seek immediate medical help. After a course of conservative treatment and perhaps a corticosteroid steroid injection, most patients are offered the option of surgery for Morton’s neuroma. Do you really need surgery? Is so when?
Do I Need Surgical Intervention For Morton Neuroma management?
There is no urgent need for surgery because Morton’s neuroma is not a tumor or malignant lesion. However, if you are experiencing pain, discomfort, numbness or a pin and needles or tingling feelings in your foot, several non- surgical options must be considered before surgery.
Most importantly, your diagnosis of Morton’s neuroma must be accurate and correct before you consider any procedures or surgery. In other words you should know that you have a Morton’s neuroma and that your Morton’s neuroma is the cause of your foot pain. For information on the diagnosis of Morton’s neuroma see here.
Ideal Treatment Options For Morton’s Neuroma:
In clinical practice, surgical removal of your Morton’s neuroma is the least preferred treatment for Morton’s neuroma and should be only performed after all other non-surgical procedures have been tried.
We recommend the following non-surgical procedures before surgery:
- Ultrasound guided Cryosurgery
- Ultrasound guided Radiofrequency ablation
- Ultrasound guided neurolytic injections
- Ultrasound guided Platelet Rich Plasma injections
- Stem Cell Therapy
It is important to consider that some individuals (those with long complex histories or who have had numerous procedures,) may sometimes require more than one sessions of radiofrequency or cryosurgery (depending upon the site and severity of your Morton’s neuroma) to induce complete resolution of symptoms. However when done by experienced providers, these ultrasound guided procedures are safe and very effective.
Surgical Intervention For The Treatment of Morton’s neuroma:
Surgical intervention is usually reserved as a last resort; when no other therapeutic solution works. For example, when you have had multiple interventional procedures under ultrasound guidance and your pain is still present and irritating you or even getting worse. At that point, it may be important to have your doctor double check your diagnosis before surgery and possibly have an MRI to exclude other conditions that may mimic Morton’s neuroma.
Most healthcare providers avoid Morton’s neuroma surgery because:
- The success rate of surgery is around 70% at best(1);
- The rate of complications is fairly high. For example, more than 72% patients develop permanent numbness (or loss of sensations) in the area of involvement. Other common complications include; painful scar formation, neuroma stump formation, infection and other ailments(2);
- A fair percentage of surgical patients experience recurrence of neuroma after surgery (at a different site or in the vicinity); and,
- The return to normal day-to-day activities can take months after surgery. On the other hand, the return to activity is very short with most ultrasound-guided procedures.
In summary, based on the latest data and clinical estimates, lifestyle modification and the ultrasound guided minimally invasive procedures listed above are highly effective in resolving most cases of Morton neuroma. Surgery should be left as a last resort.
- Chuter, G. S., Chua, Y. P., Connell, D. A., & Blackney, M. C. (2013). Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal radiology, 42(1), 107-111.
- Kasparek, M., & Schneider, W. (2013). Surgical treatment of Morton’s neuroma: clinical results after open excision. International orthopaedics, 37(9), 1857-1861.
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.