Both Decompression and Neurectomy Surgery for Morton’s neuroma are usually not recommended due to a high complication rate.
Should I have Morton’s neuroma surgery? (or why shouldn’t I have Morton’s neuroma surgery?)
In some patients Morton’s neuroma surgery is unavoidable because their Morton’s neuroma is resistant to any other means of treatment. However in the vast majority of cases surgery is avoidable. (We only consider surgery for Morton’s neuroma as a last option when all other non-surgical treatments have failed.)
There are two types of Morton’s neuroma Surgery: Decompression Surgery or Neurectomy Surgery.
Both are usually not recommended due to high risk and high complication rate. We generally recommend Ultrasound guided Ablations instead of surgery but we would consider surgery for Morton’s neuroma as a last option when all other non-surgical treatments have failed.
| DECOMPRESSION SURGERY | NEURECTOMY SURGERY | |
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The nerve is not cut but the overlying tendon is cut(i.e. the nerve is “released” or “decompressed”). |
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What is it? |
The nerve is not cut but the overlying tendon is cut(i.e. the nerve is “released” or “decompressed”). |
The nerve is cut and the neuroma is removed |
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Advantages: |
No cutting of the nerve. |
None |
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Disadvantages: |
Risk or foot instability. Morton’s neuroma decompression surgery cuts the Deep Transverse Metatarsal Ligament which can result in post operative foot instability, with forefoot splaying and potential long term gait problems. |
Risk of post-surgery pain. Studies have shown that up to 35% of patients who have had Morton’s neuroma neurectomy surgery end up with unacceptable levels of post-surgical pain, also known as “post neurectomy pain”. |
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Additional Problems: |
Long recovery time. Typical recovery times is 8-12 weeks, and you will be in a surgical boot for the first 4-6 weeks. Physical therapy will be needed. |
Long and difficult recovery time. The first 2 weeks you need to be as sedentary and be in a surgical boot for 4-6 weeks. Typical recovery times is 8-12 weeks. Physical therapy will be needed. |
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Alternatives: |
Ultrasound Guided Ablations. We can effectively treat Morton’s neuroma without any surgery and, in many cases, more effectively than surgery. Recovery time from our procedures is only a couple of days with no surgical risks, no need for a surgical boot, and no physical therapy. |
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When to consider: |
If Ultrasound Guided Ablations fail. In most cases Ultrasound Guided Ablations are effective in significantly decreasing pain and increasing function, but in the unlikely case that these fail Morton’s Neuroma Decompression Surgery is an option. |
If All Else Fails. If everything else failsthen neurectomy may be your last option (or a peripheral nerve stimulator). |
We can effectively treat Morton’s neuroma without surgery, (in many cases more effectively than surgery) and the recovery time from our procedures is only a couple of days.
For more information on the non surgical options we offer to treat Morton’s neuroma, CLICK HERE.
Surgery for Morton’s neuroma is often associated with complications, most commonly post surgical pain. In many cases the post surgical foot pain may be as bad or worse than before surgery. Some studies have shown that up to 35% of patients who have surgery end up with unacceptable levels of post surgical pain.
Post Morton’s neuroma surgery foot pain is much more difficult to treat than pre surgery Morton’s neuroma foot pain because the exact cause of your pain after Morton’s neuroma surgery can be difficult to determine. It can even be difficult to localize the exact position of your pain after surgery! Post Morton’s neuroma surgery pain can be due to a stump neuroma, nerve degradation, scar tissue or another post surgical complication. For more information on pain after Morton’s neuroma surgery (“post neurectomy pain”), click here.
Most first time Morton’s neuroma surgery is done through the top of the foot (the “dorsal” approach) which involves cutting through the transverse metatarsal ligament. Although this results in a shorter recovery time than operating through the bottom of the foot, it results in more post operative foot instability, with forefoot splaying and potential long term gait problems.
The basic recovery time from Morton’s neuroma surgery is frequently 3 or possibly 4 weeks, even if a top of the foot (“dorsal”) surgical approach is used and it can easily take 3-4 months to for the full effects of surgery. In other words, it can take 3-4 months to become fully mobile.
If another surgery is required, the success rate of a Morton’s neuroma redo surgery is considerably lower than the success rate of a first time Morton’s neuroma surgery. The redo Morton’s neuroma surgery is most commonly done through an incision in the bottom of the foot (the “plantar aspect” of the foot.) This approach results in an even longer and more painful recovery than a regular Morton’s neuroma surgery. It can take 4-6 months of painful recovery to fully recover from a redo Morton’s neuroma surgery.
There are always general surgical risks associated with any surgery and so surgery should always be avoided if possible.
However, in some cases when Morton’s neuroma is resistant to other treatments, surgery is the only option left and is unavoidable.
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