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.
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.
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:
- Wearing high heeled shoes – Wearing high heels causes excess pressure on the balls of your feet. That pressure can irritate the internal anatomy of your foot and cause a Morton’s neuroma.
- Wearing tight shoes – Overly tight shoes with a narrow toe box can lead to excessive pressure on the balls of your feet. Always choose comfortable shoes with a wide toe box. Shoes should feel natural, not constrictive!
- Athletic pursuits – Running, jogging, playing tennis and other sports that include high-impact movements of the feet can bring on Morton’s neuroma.
- Other foot complications – Another foot issue such as bunions, hammer toes, flat feet, high arches or any other foot deformity can affect the movement of the foot and exert additional pressure on the nerves of the toes, leading to 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.
Gail underwent an excision of a Morton’s neuroma in 2013. Though the surgery initially gave her some relief, the area on the ball of her foot continued to experience pain, which made it difficult to walk for any extended period of time. The pain gradually increased over time, until it became severe and radiated out to her second and third toes. Gail described the pain as “burning with electrical shocks.” With this increased level of pain, Gail had to stop participating in some of her favorite activities, like golf.
After a nerve decompression surgery with Dr. Tollestrup, Gail reports taking long walks again without pain and can’t wait to hit the links again.
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.
Ronald came to us after undergoing an excision of a Morton’s neuroma that did not solve his foot pain. The doctor who performed Ronald’s excision did so through an incision on the top of his foot. An MRSA infection after the surgery complicated Ronald’s healing process, which lasted for months.
After the first surgery, Ronald experienced chronic pain in the ball of his foot, so he opted for a second surgery to re-excise the Morton’s neuroma. This time, the incision was made on the ball of the foot. Not only did this surgery not correct his neuroma, but his pain actually became worse and spread to the entire ball of his foot and his first three toes.
Finally, Ronald came to see Dr. Tollestrup. Dr. Tollestrup created a plan to excise Ronald’s Morton’s neuroma for good. During surgery, the doctor made an incision on the non-weight-bearing section of Ronald’s foot arch. Once inside the foot, Dr. Tollestrup could see the many damaged nerves that were responsible for Ronald’s ongoing foot pain. Dr. Tollestrup disconnected the damaged nerves and placed nerve grafts onto the end of Ronald’s nerves to prevent painful neuromas from forming again.
Five months after his surgery, Ronald is “100%” better and is able to walk again without the constant pain he had prior to surgery with Dr. Tollestrup.
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.
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.
The Tollestrup Team Can Help
Dr. Tim Tollestrup and his team can help. Call us at 702-666-0463 or fill out the form on this page to set up a consultation to determine your options.