What Is Morton’s Neuroma Excision?
Morton’s neuroma excision is a surgical procedure to remove a thickened nerve (neuroma) most often found between the third and fourth toes. It relieves burning pain, numbness, or tingling caused by chronic irritation or compression of the interdigital nerve in the forefoot.
When Is Excision Recommended?
Surgery is considered when conservative treatments fail to provide lasting relief. Common indications include:
- Persistent forefoot pain interfering with daily activities
- Failed response to shoe modifications, orthotics, or padding
- Ineffective nerve injections (steroids or alcohol)
- Neuroma larger than 5 mm on ultrasound or MRI
- Significant sensory changes (numbness or sharp shooting pain)
How Is Morton’s Neuroma Excision Performed?
- Anesthesia and Positioning: The patient lies supine. A regional (ankle block) or general anesthetic is administered. A thigh or calf tourniquet may be applied to limit bleeding.
- Incision and Exposure: A small transverse or longitudinal incision is made on the top or bottom of the foot over the affected interspace. Soft tissues are carefully dissected to expose the neuroma.
- Neuroma Identification and Removal: The surgeon isolates the enlarged nerve segment and excises it, taking care to cut cleanly proximal to the neuroma to minimize recurrence. Any surrounding scar tissue is gently released.
- Closure: The wound is irrigated, hemostasis ensured, and layers are closed with absorbable sutures. A sterile dressing and a post-operative shoe or boot are applied.
Recovery After Excision
- Immediate Post-Op (Weeks 1–2): Keep the foot elevated and use crutches or a walking boot to offload pressure. Dressings are changed regularly.
- Early Mobilization (Weeks 3–6): Begin gentle range-of-motion exercises and partial weight-bearing in a stiff-soled shoe. Sutures typically dissolve or are removed at 2–3 weeks.
- Rehabilitation (Weeks 6–12): Progress to full weight-bearing in supportive footwear. Introduce strengthening and balance exercises to restore forefoot mechanics.
- Return to Activity: Most patients resume normal walking and low-impact activities by 8–12 weeks; high-impact sports may wait until 4–6 months post-op.
Risks of Excision
While generally safe, potential complications include:
- Wound infection or delayed healing
- Residual numbness in the toes or forefoot
- Stump neuroma (recurrence of painful nerve end)
- Scar tenderness underfoot
- Altered gait mechanics leading to metatarsalgia
Benefits of Excision
When successful, neuroma excision offers:
- Durable relief from burning pain and tingling
- Improved walking comfort and shoe tolerance
- Restoration of normal foot function
- Elimination of repeated steroid or alcohol injections
