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Morton's Neuroma Surgery Advisable?

Posted by Heather H. on 8/18/04 at 12:53 (158342)

My podiatrist has diagnosed me with Morton's Neuroma and I have all the classic symptoms. He has recommended out-patient surgery under general anesthesia in the hospital to remove it. I have had this condition for about 3 years and while it is not debilitating, I have consistent, localized aching and pain. An X-ray of my foot did not reveal a neuroma, but was clear, which he said was expected to rule out other issues. Does this sound right? Should it have shown up on the X-ray? Should I request an MRI? Is there any problem with a podiatrist doing the surgery or advantage of using an orthopedic surgeon instead? Is it true that 15-20% of these surgeries are ineffective? Is this considered very simple surgery or high risk of serious complications? Is it necessary to have this done in a hospital with general anesthetic? Why not local anesthetic in his office? How can I find out if this doctor is well qualified with a good track record on this type of surgery? Given that it's not severly painful, would I be better off living with it or getting it excised, given expected success rates and complications?

Re: Morton's Neuroma Surgery Advisable?

Dr. Z on 8/18/04 at 20:38 (158366)

If you can live with the pain and are able to wear shoes that are comfortable then why have surgery.? Are you walking differently? Are you able to not have to take your shoes off for relief? If the answer is no, then why have foot surgery

Re: Morton's Neuroma Surgery Advisable?

Darlene on 8/18/04 at 20:45 (158367)

Heather:

I am not a doctor, but here's what I've learned.

A simple, cost-effective way to diagnose morton's neuroma is with a diagnostic ultrasound. Is your pain between your 3rd and 4th toes at the metatarsal heads?

Have you tried orthotics to offload your forefoot. The metatarsal pads in the orthotics also help to spread the metatarsal bones so that the neuroma is not squeezed.

A general anesthetic sounds extreme for morton's neuroma surgery. I had surgery in the podiatrist's office, but I think a better option would be a hospital with sedation and a local. I found the injection of the local to be very painful as he injected it right into my neuroma (ouch!!!).

Morton's neuroma surgery is usually done through the top of the foot, but the neuroma is actually at the bottom below the intermetatarsal ligament. Therefore they normally cut the ligament to get to it, which in my case resulted in the metatarsal head dropping. One podiatrist I spoke with after said they he puts a few stitches in to reattach the ligament. It sounded like a good idea. Perhaps the doctor's have an opinion on that.

Regarding success rates, you should ask the doctor about his or her track record. A couple of doctors told me that they have never had a problem with stump neuromas (this is when the nerve grows back into the weight bearing area of the foot). Apparently if the nerve is taken far enough back it should not be a problem.

Another option is alcohol sclerosing. A number of injections are required about a week apart (usually about 7). Again, you would have to go with someone who has had good success with this procedure.

Hope this helps.

Darlene

Re: Morton's Neuroma Surgery Advisable?

Ed Davis, DPM on 8/18/04 at 22:36 (158378)

Darlene:
Good information -- you have a good understanding of this. If one were to compare the amount of patient discomfort of 7 sclerosing injections (injecting the nerve) vs. removing it at one session, I would say that there is less total discomfort with removal.
Ed

Re: Morton's Neuroma Surgery Advisable?

Maverick on 8/24/04 at 16:51 (158635)

Allow me to weigh in I have had quite some experiences with a morton's neuroma. In April 2003, I had mine removed surgically from my right foot by a very good Podiatrist after orthotics + cortesone injections didn't work. This was done at a local hospital using local anesthetic. Removal was from the top of the foot and didn't hurt at all. By about June 2003, the nerve unfortunately begun to grow back (condition called stump neuroma) which is a real pain to deal with. Since then, I have tried new orthotics, alcohol injections, cortesone injections and acupuncture to no avail. You should consider that a stump neuroma is possible from surgery (although rare). You should check out this doctor that I found on the internet that sells something called Theta-Orthotics. I'm currently wearing mine and hope this will take care of the problem. This Doctor Wayne Jarrett advises folks to try his 'aggressive' correction (by that he means much more of an angle to support your arch -- he calls it the 'theta'). I suspect these could work very well, although I'm still trying mine out. The website is http://www.theta-orthotics.com . Hope this helps !

PS: I only went for 4 alcohol injections and stopped b/c they didn't seem to be helping much. I wonder if I should have continued up to 8 injections. The problem is that they are extremely expensive (US$ 350 per shot).

Re: Morton's Neuroma Surgery Advisable?

Pauline on 8/24/04 at 19:40 (158642)

Maverick,
I think you offered good advice. It's just too bad one can't drink the alcohol it sure would be a lot cheaper. I hope your new orthotics work.

Re: Morton's Neuroma Surgery Advisable?

NEmens on 8/30/04 at 15:36 (158993)

I am also in the process of considering surgery for a neuroma in my foot. All posted information is helpful and has given me ideas of questions to ask my own podiatrist. One of my concerns is about recovery time. My dr. suggested that post-op it is best to stay off my feet for one full week.
I've been using advil, padding, new shoes and cortizone for 2 1/2 years now.

Anyone think that the surgery is a worthy exchange for the pain from the neuroma?

Re: Morton's Neuroma Surgery Advisable?

uninformed on 9/02/04 at 21:56 (159199)

Don't do it. RSD from Morton's Neuroma Surgery over a year ago, is still a nightmare of pain. The one inch cut on the top of my foot caused pain immediately up to my hip. Research RSD and symptoms. To make matters worse, the Doctor didn't cut the nerve back far enough and I hurt more now with every step than the tender spot I had before surgery. I now wear a $465. shoe to keep from limping. I wasn't imformed of this option before surgery or the risk of RSD and its symptoms. I was dibilitated for over a month in the bed with muscle atrophy before proper referral to pain management for injections. My entire leg still goes to sleep when I sit or try to ride in a car for even 1 hour periods. I wish I had not had the surgery every day.

Re: Morton's Neuroma Surgery Advisable?

Darlene on 9/02/04 at 22:15 (159201)

I'm sorry to hear about your pain. I also had morton's neuroma surgery which has led to a ongoing foot and ankle pain, now in both feet.

I'm curious as to what type of shoe you are wearing.

I hope you continue to see improvement.

Darlene

Re: Morton's Neuroma Surgery Advisable?

MaryQ on 9/06/04 at 20:26 (159452)

Neuroma in left foot. Shot, medicine, expensive orthotic haven't worked. Now i have a wobbly left knee and pain in my right hip as well as the original neuroma pain. Is there a common denominator among those for whom surgery was a greater pain than the neuroma? Weight a factor? Experience of doctor a factor? Time off foot after surgery a factor? Age a factor? Demand on foot of job after surgery a factor? I don't get the connection between neuromas in the ball of the foot and heelspurs.

Re: Morton's Neuroma Surgery Advisable?

Dr.Brent Jarrett on 9/06/04 at 23:48 (159465)

I am the doctor who treats foot problems including neuromas and heel spur agressively with my new theta-orthotics. Heel spurs and neuromas are both caused by break down of the arch and the pressures placed on a variety of different structures. In fact they are number one and number two most frequently seen problems in a Podiatrists office. Since I invented these new orthotics the Operating Room personel at the two hospitals I work out of both accuse me of taking all of my neuromas and heel spurs to the other hospital. They don't believe me when I tell them I treat them all conservatively with orthotics. BTW the best podiatrist or orthotpedist gets frequent poor results with neuroma surgery, heel spur surger actually wors quite well but it does not address the cause of the myriad of other foot and leg problems that will continue to occur. Dr. Jarrett

Re: Morton's Neuroma Surgery Advisable?

jvander on 9/20/04 at 13:22 (160200)

I am just about 3 weeks post Morton's neuroma excision and bunionectomy on right foot. Quite painful. I stayed off foot for 1 week. Then went back to work but kept foot up most of the time. I'm thinking the neuroma surgery was the most painful. Most pain is gone now but still feels numb and like a sock is bunched up under my ring toe. Will this go away??

Re: Morton's Neuroma Surgery Advisable?

Betty M. on 9/21/04 at 23:56 (160315)

Due to unbearably painful Morton's Neuroma,I had the effected nerve removed from my left foot, in the Podiatrist's office, about eight (8) years ago, with five brave and curious grandchildren watching the surgery (incision made on bottom of foot). I had to stay off my foot for approximately two weeks. It healed well, and the pain was gone for perhaps a couple of years, although my right foot remained as painfully affected as the left had been. I had planned to have the nerve in my right foot surgically removed, but when the pain in left foot returned and became as painful as it had ever been, I dismissed any ideas of further surgery. I don't know if the nerve grew back, but I felt more than likely, the nerve between two other toes on that foot had become victims of Morton's Neuroma. I realize that to have all painful nerves removed, would leave me with basically numb feet from arch through toes, and I would be left with a 'foot flap' situation, which for me is definitely not an option. I read about a newer surgery that seemed to work without losing the feelings in the effected nerves. It had to do with pulling tissue away from nerve, easing stress on nerve...or something like that. Does anyone know anything about this procedure? Thanks, and my sympathies to you fellow sufferers.

Re: Morton's Neuroma Surgery Advisable?

Darlene on 9/22/04 at 10:07 (160335)

I think you are referring to a ligament release surgery. They cut the deep intermetatarsal ligament (which holds the bones of the toes together at the met heads). I had this done and am much worse after. It may work for brand new neuromas that are very small with little scar tissue. Also, the ligaments that are severed are there for a reason and my met head dropped as a result.

What did the doctor say? I thought that incisions from the bottom allowed better visualization and less chance of a stump neuroma.

Have you had a diagnostic ultrasound or MRI to see what is going on in there?