Surgery for Morton’s neuroma

How do we evaluate whether a patient requires surgery for Morton’s neuroma?

Your PiedRéseau clinics can provide you with an evaluation throughout Québec. The local podiatrist can then contact a podiatrist to follow up on your condition. You will be given all the information you need to make the right decision to treat Morton’s neuroma. 

You will be given a customized surgical plan, which you are then free to approve. 

The patient’s medical history is very important

With the history of your pathology, a podiatrist can determine the reasons why Morton’s neuroma appeared on your foot. 

The foot’s morphology or the types of shoes worn are some of the main factors that can determine how the neuroma developed. 

Initial conservative treatment methods

Before electing to have surgery for Morton’s neuroma, it is very important to list what you have already tried or what can be tried. For example: 

• Wearing wide and proper fitting footwear 
• Wearing properly adjusted foot orthotics
• Physical therapy techniques, including massages, ultrasounds and laser therapy
• Applying ice compresses and taking anti-inflammatory medication
• Cortisone injections

However, sometimes the situation is so advanced that it is impossible to correct it with conservative treatments, opting instead for surgery to treat Morton’s neuroma. 

Clinical examination

The clinical examination is used to assess whether you are a candidate for Morton’s neuroma surgery. During this part of the examination, the podiatrist identifies your surgical history, your medical history, medication and any allergies you may have. 

In addition, a vascular assessment of your feet will be conducted to ensure optimal healing.

X-ray, ultrasound and MRI evaluation of your foot

Generally speaking, the evaluation of your foot is divided into 3 steps:  

X-ray

An X-ray of your bone structure will be taken to establish a surgical plan and ensure that there is no bone pathology linked to your neuroma. 

Ultrasound

An ultrasound is an examination performed in a podiatry clinic or a radiology clinic. This is an important step in making the best diagnosis of your neuroma. 

Other foot conditions appear similar to Morton’s neuroma. A diagnosis through imaging can clearly detect the pain that is radiating through your foot. Following this, a cortisone injection can be administered, with or without an ultrasound, to relieve the neuroma.

Magnetic resonance imaging (MRI)

Magnetic resonance is ideal to accurately measure Morton’s neuroma. This technique allows us to view its aspect, its arrangement or its deterioration. 

In addition, the MRI makes it possible to properly prepare the operating protocol and ensure that nothing has been forgotten.

Procedures to remedy your Morton’s neuroma

Below are the various ways to proceed: 

Plantar approach procedure (under the foot)

This approach provides direct access to the neuroma under the foot to extract it through an excision. The risk of recurrence with this type of operation is low. 

It is not advisable to choose this solution if you tend not to heal properly or if you have a lot of foot calluses. 

Note that this procedure does not allow you to walk on your foot for a period of 21 to 28 days.

Dorsal approach procedure (top of foot)

The dorsal approach procedure provides excellent results, but can affect the tissue under the bones of your feet more. This is a common method that minimizes the risk of painful plantar scars.

Between the toe procedure

The between the toe procedure completely eliminates the risk of plantar scarring. In addition, it reduces structural stress between the bones in the forefoot. 

However, the podiatrist may have more difficulty accessing the neuroma when performing this type of operation. The risk of recurrence is also higher.

Since no single procedure is perfect, it is important to discuss your condition and expectations in detail with your podiatrist. This will help you decide upon the procedure best suited to your condition. 

Chronological steps of Morton’s neuroma surgery

These 4 steps, followed in order, enable your podiatrist to properly treat you: 

Pre-surgery assessment

This step can be conducted several weeks before the procedure. You will be given a treatment plan and have the time to make a clear and informed choice about the desired treatment.

Surgical preparation

This begins a few weeks before surgery:

• Sometimes, some patients require a blood test and prescription for antibiotics before surgery.
• You must allow for a convalescence and rest period following surgery.
• You must be accompanied by someone for the surgery, and they must be available to assist you for 24 to 48 hours following the operation.
• Your foot must be properly cleaned.
• In some more rare cases, fasting is required 12 hours before surgery.

Most procedures take place without IV sedation and general anaesthesia. 

The day of surgery

For everything to proceed as planned, the following must be done: 

• If required, you must take any medication 2 hours prior to surgery, or as per the instructions of your podiatrist. 
• Time is set aside for surgical preparation at the clinic. You will then be made comfortable and cared for.

Normally, foot surgeries take place with general anaesthesia and anxiety-relieving medication. 

Back home

To heal properly, you must be aware of some important information to follow after your operation: 

• The anaesthesia will last for several hours. Pain medication will be prescribed, and you should start taking it while you are still under anaesthesia to prevent feeling any pain.
• You will return home with the person accompanying you on the same day as the operation.
• Try to keep your leg elevated as much as possible, and apply an ice pack.
• You must always keep your foot dry.

It is especially important not to touch your bandages, unless otherwise directed by your podiatrist!

Follow-up visits and home care

Each procedure requires special care at home. Follow the personalized home care plan provided by the clinic’s team. A follow-up appointment will also be scheduled, within 3 to 7 days following the operation. 

Stitches will remain in place for 2 to 4 weeks, depending on the individual case. 

Possible biomechanical complications and special cases

Your podiatrist’s training enables them to recognize and prevent any possible biomechanical complications of surgery. The podiatrist can thus prevent certain new pathologies, such as capsulitis or calluses, from developing.