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Failed Morton’s Neuroma Surgery Treatment

Failed Morton’s Neuroma Surgery

What is Morton’s Neuroma?

Morton’s neuroma is a painful condition that affects the ball of the foot, most commonly between the third and fourth toes. Patients describe it as feeling like they are stepping on a pebble, with sharp, burning pain in the ball of the foot that sometimes radiates out and causes pain and numbness in the toes, as well.

Morton’s neuroma is caused by a thickening of the tissues that surround the nerves leading to your toes. That thickening compresses the nerve, causing pain, burning, and numbness. Anything that causes injury or irritation to the ball of the foot can cause a Morton’s neuroma. Common causes include improper footwear, high-impact sports, and other foot conditions.

Has a Morton’s neuroma kept you from activities you love, like hiking, walking, golfing or dancing? This painful condition is actually quite common, and every year, thousands of people undergo surgery for Morton’s neuroma. Unfortunately, traditional surgery for Morton’s neuroma is not always successful and can sometimes even make foot pain worse. Dr. Tollestrup has pioneered a procedure that helps Morton’s neuroma sufferers find relief at last, whether this is their first neuroma surgery or not.

Risk Factors for Morton’s Neuroma

Some people are more likely to suffer from Morton’s neuroma than others.

Here are some factors that increase your risk of developing a Morton’s neuroma:

Hope after a failed Morton’s neuroma surgery

Good data on the long term efficacy of cutting out Morton’s neuromas is hard to come by. However, studies indicate that only about 50% of patients who undergo traditional surgical removal of the swollen nerve report “excellent relief” of their pain at a 10-year follow up. In addition, as many as 35% of patients report unacceptable levels of post-surgical pain, and patients often experience much worse pain after surgery than they did before.

Patients who continue to experience unacceptably high levels of pain are designated as having “failed Morton’s neuroma surgery.” Traditionally, there have been no good options for these patients. They will often undergo repeat surgeries, often via incisions through the weight-bearing balls of the feet. These poorly placed incisions cause scarring and loss of the fatty padding that cushions the metatarsal-phalangeal joints of the foot. Repeat surgery typically focuses on cutting out the new neuromas and hoping for the best. This approach is rarely successful and often leads to adjacent nerves being damaged, creating a downward spiral of pain for the patient.

We see countless patients who underwent a surgery for Morton’s neuroma that did not relieve their pain. They come to our office thinking all hope is lost, but luckily, there is a new surgical option that helps patients who have undergone a failed Morton’s neuroma surgery be pain-free once and for all!

Nerve Decompression Surgery for Morton’s Neuroma

If you’re suffering from a painful Morton’s neuroma and have never had a prior surgery to address it, the best approach to treating your Morton’s neuroma is to surgically decompress the nerve. Nerve decompression surgery for Morton’s neuroma is usually the right choice unless there has been significant blunt or penetrating trauma to the affected nerve or nerves.

Denervation surgery for Morton’s neuroma

If you have had a prior Morton’s neuroma surgery that has failed and you’re still experiencing pain in the ball of your foot, the best approach is one that Dr. Tollestrup developed. In Dr. Tollestrup’s denervation surgery for Morton’s neuroma, an incision is placed in the non-weight-bearing part of the arch of the foot, and the damaged nerve or nerves 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 instead of forming a painful new neuroma.

Why traditional Morton’s neuroma surgery fails

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

The correct treatment for this type of nerve compression is to surgically decompress the nerve by dividing the transmetatarsal ligament and any other tissue that 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.

Patients who undergo a traditional Morton’s neuroma excision that does not alleviate their symptoms will often undergo further attempts to kill the nerve with alcohol injections. They may even try multiple additional surgical procedures, each time cutting the nerve back a little bit more. The painful neuroma will invariably reform, however, and the patient will often experience worse symptoms as time passes. These patients can become absolutely debilitated over time.

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Can Morton’s neuroma come back after surgery?

Morton’s neuromas can return after traditional Morton’s neuroma surgery. When the affected nerve is cut in the weight-bearing section of the foot, that leaves that nerve open to the same pressure and irritation that created the first Morton’s neuroma. Therefore, a new Morton’s neuroma can form.

With Dr. Tollestrup’s Morton’s neuroma surgery, the neuroma will not return, as the end of the nerve is no longer located in the weight-bearing portion of the foot. Also, a nerve allograft is sewn onto the end of the patient’s nerve, which prevents a new Morton’s neuroma from forming.

Morton’s neuroma surgery recovery time

Recovery after Morton’s neuroma surgery is generally quick. You’ll be able to walk on your operated foot while wearing a post-op shoe in the first two to four weeks. You’ll be able to return to wearing normal shoes within two to six weeks.

How soon can I drive after Morton’s neuroma surgery?

If the surgery is performed on your left foot, you can drive right away. But if the surgery is performed on your right foot, you’ll need to wait until you can wear real shoes before you can drive again. For most people, that’s between two and six weeks.
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Success Stories
See how we’ve helped change the lives of some of our patients. Hear their stories below:
Chronic Pain Relief Patient with Multiple Peripheral Nerve Problems
Over five years, Dr. Tollestrup performed multiple nerve decompression and denervation surgeries on Gail including a piriformis muscle removal. Dr. Tollestrup calls her one of the most complex patients he has ever operated on. This is her incredible story in her own words.