Failed Morton’s Neuroma Surgery Patient Gets Relief with Nerve Decompression Surgery

Failed Morton’s Neuroma Surgery Patient Story

Failed Morton’s Neuroma is a common problem that brings many patients to Dr. Tollestrup. Gail is one such patient. She shared her story in hopes of reaching others like her.

Here are Dr. Tollestrup’s patient notes on Gail. We are so happy to see she is doing well!

After a failed Morton's Neuroma Surgery Gail found relief after nerve decompression surgery with Dr. Tollestrup.

After a failed Morton’s Neuroma Surgery Gail found relief after nerve decompression surgery with Dr. Tollestrup.*

“Gail is a 73-year-old woman who presents for evaluation of pain in the ball of the right foot. She underwent an excision of a “Morton’s neuroma”, in 2013. Although this surgery gave her some relief, she continued to have pain in this area making it difficult to walk for extended periods.

Approximate six months ago, the pain in the area of the Morton’s neuroma excision started to become much more severe with radiation of pain into the second and third toes. She describes the pain as “burning and electrical shocks.” The pain is now significantly impacting her ability to walk and enjoy some of her favorite pastimes such as golf.

A “Morton’s Neuroma” is a common diagnosis. This is not a true neuroma but orthopedic surgeons, podiatrists, etc. are not aware of that. It is in fact just a compression of the common plantar digital nerve between the metatarsal heads where the nerve must pass underneath the transmetatarsal ligament. This compression point often produces some swelling in the nerve which is then misinterpreted on ultrasound or MRI as a true neuroma.

The correct treatment for this type of nerve compression should be to surgically decompress the nerve by dividing the transmetatarsal ligament and any other tissue which is compressing the nerve. Traditional teaching, unfortunately, has been to cut out the swollen nerve (thinking it is a neuroma) and letting the proximal end of the nerve retract back up into the foot. Sometimes this works and sometimes it doesn’t.

For patient’s who fail this approach, there are not many good options. They will often undergo attempts to kill the nerve with alcohol injections and may undergo multiple additional surgical procedures, each time cutting the nerve back a little bit. The painful neuroma will invariably reform, however, and the patient will often experience worse symptoms over time. These patients can become absolutely debilitated over time.

The best approach for these patients is one I developed whereby the incision is placed in the arch of the foot and the correct nerve or nerves which are damaged are identified and disconnected. Then a cadaveric nerve allograft is micro surgically sewn on to the end of the native nerve. This allows the native nerve end to grow into the graft which is long enough that it can’t reach the other end. The native nerve ends up “burning itself out,” so to speak, which prevents it from forming a new painful neuroma.

In Gail’s case, she loved taking longs walks and was to the point where she could barely walk at all without horrible pain in the right foot.

She is now about 10 weeks out from her surgery and is back taking long walks without any pain in the bottom of her foot.

If you or someone you know is suffering from chronic pain Dr. Tollestrup can help. Call our office at 702-666-0463

*Disclaimer

We do not guarantee any specific results or outcomes for surgery, should our practice work on your behalf. Information on this website may be used as a reference for successes we’ve achieved for our patients, and not as an assurance or guarantee for similar results in all instances.

Join the discussion 2 Comments

  • Gloria Cherchio says:

    Dr You state at the beginning that many times it’s misdiagnosed as a Morton’s neuroma by orthopaedic doctors and MRI’s. But It appears that towards the end of the discussion you reference that your procedure short cuts the ability for the neuroma to grow back, also that alcohol injections and additional surgeries often allow or cause the neuroma to grow back. So my question and confusion is, are we speaking of a neuroma or a compression of a nerve that is diagnosed wrongfully as a neuroma. I ask this because I have had neuroma surgery and continue to experience the same lingering effects of pain and swelling as the patient here. I don’t want to once again go through a surgery aimed at a neuroma if it’s not. I did come to you a couple of years ago but did not go forward due to the concern stated.

    • admin says:

      For 99% of patients who are diagnosed with a “Morton’s neuroma,” the problem they actually have is a nerve compression. A nerve compression should be treated by relieving the pressure on the nerve rather than cutting it. The vast majority of physicians or podiatrists who treat this condition are under the mistaken impression that the pathologic condition represents a true neuroma rather than a nerve compression and they are taught to cut the “neuroma” out of the foot. This unfortunately leaves the patient at risk for developing a real neuroma. If you have had a previous “Morton’s neuroma” surgery and are still having pain, then you are now dealing with a true neuroma. I would need to read the operative note from your Morton’s neuroma surgery to know for sure what was done but most likely they cut your nerve at that time. To correct this problem, you will need an approach through the arch of the foot where I identify the injured nerve(s), cut of the neuroma, and use a nerve graft to prevent another neuroma from forming.

      Dr. T

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