Neuromas

The pain in your foot is thought to be due to a neuroma.  The neuroma is a swelling, or thickening of nerve tissue caused by irritation, compression, or trauma to the nerve under your foot just before the toe web-space. In the foot, the most common type is Morton’s neuroma, which typically affects the 3rd inter-metatarsal space between the 3rd and 4th toes.  This condition often develops due to repetitive pressure or irritation, such as wearing tight or high-heeled shoes or engaging in high-impact activities.  Patients with neuroma commonly experience symptoms like burning or sharp pain in the ball of the foot, tingling or numbness in the toes, and a sensation of walking on a pebble.

While conservative treatments such as footwear modification, orthotics, anti-inflammatory medications, and corticosteroid injections can provide relief in many cases, persistent or severe symptoms may necessitate surgical intervention. This will lead to numbness of the adjacent toes but should not affect mobility. The goal of neuroma excision surgery is to remove the affected nerve and alleviate the associated pain, restoring the patient’s ability to walk and perform daily activities comfortably.

The Procedure

The surgery usually involves making an incision on top of the foot via which the nerve is being removed.  The inter-metatarsal ligament is carefully divided to expose the affected nerve.  The thickened portion of the nerve (neuroma) is identified and excised. The proximal portion of the nerve is repositioned or embedded into surrounding tissue to minimize the risk of painful scar tissue (stump neuroma).

Occasionally, this procedure is carried out via an incision under your foot and if this does happen you will need crutches after surgery. If this is the case the post-op instructions differ – this will be discussed with your surgeon. The wound will be closed using non-dissolvable stitches.

Possible Complications Related to Neuroma Surgery

Pain

There may be post-op pain. For most people the pain passes after 24-48 hours and is tolerable with regular painkillers (following dosage recommendations).  You may develop pain in adjacent parts of the foot after surgery which were not originally apparent at the time of surgery.

Stump Neuroma

In a small percentage of patients the operation is unsuccessful and can lead to a painful nerve ending. This is a ‘Stump Neuroma’ and is uncommon. It can occur if you are too active in the post-op period. Reports differ but it is believed to occur in about 5-20% of patients. It can be treated by steroid injection and if severe, further surgery. Further (revision) surgery after neuroma surgery carries a significant risk of scarring and continued discomfort.  The cut piece of nerve can re-grow requiring further surgery.

Permanent Numbness

The sides of the toes supplied by the damaged nerves will be permanently numb. Most patients are aware of this when the toes are touched but not usually when walking. It rarely causes concern.

Scar Tissue

Your foot may develop scar tissue which in some people can cause a bruise like discomfort around the operation site and this may last for many months. It usually improves in time.

Allergy or reaction to surgical materials or anesthesia

It is important you discuss your complete surgical history with your surgeon prior to your procedure to ensure that previous reactions and allergies do not recur.