You have been directed to this section of the website because you have inflammation or thickening of one (or two) of the nerves in your foot. This is called a neuroma. Here you will find details on your treatment options.
Most people with a Morton’s neuroma complain of a sharp, shooting pain in the ball of their foot. For some, the pain can affect the toes and patients often report that their toes feel numb. The pain/numbness is often brought on by wearing tight fitting footwear and normally occurs with walking. Taking off the shoe and massaging the foot can often relieve the pain. The cause of neuromas is not entirely understood.
Mr McCallum is normally able to make the diagnosis after taking a history of your complaint and performing a clinical examination of your foot. In some cases, where the diagnosis is less clear cut, an injection of local anaesthetic, an x-ray, ultrasound or MRI scan may be required to confirm the diagnosis or exclude alternative possible diagnoses.
• Wide fitting footwear.
• Steroid injection.
• Anti-inflammatory and pain killing medication.
• Insoles (orthoses).
This involves excision of the thickened section of the nerve. The procedure is normally performed through an incision on the top of your foot at the base of the toes. If the operation is being done for a second time then Mr McCallum may decide to perform the surgery through an incision on the bottom of your foot.
A protective shoe will be put onto your foot before you leave the hospital. This is removable and can be taken off when resting. Crutches will also be provided when necessary.
You should travel home by car and keep your foot elevated on the back seat where possible. When you go home, you must rest with the leg elevated for the first 2-4 days (essential walking only). It is important that you do not interfere with the dressings and that you keep them dry. You can buy a purpose made waterproof device from the chemist if you wish.
Mr McCallum will review you within one week of your operation for a change of dressing and at the 2-week mark, the dressings will be removed and the sutures will be removed. You can now wash your foot as normal and return to a comfortable shoe. It is very important that you start to increase your activity levels after returning to your own shoes. Massaging around the surgical site and stretching the toes upwards and downwards will help prevent a build up of scar tissue in the surgical area, which can be painful. Some patients find these exercises uncomfortable but they are very important and you will not cause any damage to your foot.
The foot should gradually improve over the course of time but it can be up to 7-months before the foot has completely settled down.
Possible Complications following surgery:
Outlined below are the possible problems or the rare complications following foot surgery with serious outcomes. In cases where there are no accurate audit results, published results from podiatric literature have been used.
• Prolonged swelling taking more than 6-months to resolve can occur in 1 in 500 operations.
• Haematoma- a painful collection of blood under the skin. This can increase the risk of developing an infection and may require further surgery to resolve.
• Thick or sensitive scar.
• Adverse reaction to the post-operative pain killers. 1 in 50 patents report that codeine preparations make them feel sick.
• Infection of the soft tissue. 1 in every 83 operations.
• Infection of bone- osteomyelitis. This is a serious complication and in severe cases, can lead to amputation.
• Delayed healing of soft tissue or bone.
• Circulatory impairment with loss of tissue.
• Loss of sensation can occur although this is not normally permanent and can continue to improve over 18-months.
• Deep vein thrombosis (blood clot) can result in the clot travelling to the lung and this can be a life threatening condition. Deep vein thrombosis incidence is 3 in 1000 cases.
• Complex pain syndrome- a condition where the nervous system dealing with pain over reacts. This is a very painful condition that can result with even with minor trauma. It normally requires management by specialists in this condition and does not always resolve. This is a rare condition that occurs in 3 in 2500 cases.
• Recurrence of deformity or failure of the surgery.
Specific Complications following neuroma surgery:
• Recurrence of symptoms. A stump neuroma is a commonly reported complication following neuroma surgery but these are actually uncommon.
• Painful scar tissue in the surgical area. This normally improves with massage and physiotherapy.
The risk of developing a complication can be minimised when the patient and all those concerned with the operation and aftercare work together. This starts with the pre-operative screening and continues through to the post-operative regime.
The pre-operative screening helps us determine whether you are fit for surgery or if any extra measures need to be considered to minimise your risk of developing a complication. It is important that you disclose your full medical history. If there is a query regarding your health then further investigations may be required and Mr McCallum will liaise with the appropriate medical specialists. Mr McCallum and the there team will ensure that your operation is carried out safely and effectively.
You can improve your healing process and reduce the risks by:
• Adhering to the post-operative instructions, which include resting and elevating the operated foot. Keeping the wound dry and clean until advised otherwise. Please ask Mr McCallum if you are not sure what to do.
• Having a healthy diet is important; this provides the nutrition required for healing.
• Alcohol can interact with the drugs that are prescribed and can impair wound healing.
• Post-operative mobilisation will be advised; this helps improve flexibility, strength and stability of your foot.