Surgical management of Morton’s Neuroma
Surgical excision remains the most common procedure for Morton neuroma. It is most commonly performed through a dorsal or plantar longitudinal incision approach. these procedures are essentially the same, with the same goal of neurectomy (to simply cut out the nerve), differences exist in the dissection. You will lose feeling in the area after this surgery.
Dorsal Approach (from the top)- The dissection is more difficult and more inter-operative complications may occur.
Plantar Approach (from the bottom)- The dissection is very easy with little complications, but you must be in a surgical boot for 2-3 weeks so a scar or keloid doesn’t develop at the bottom of your boot.
Unique Surgical options
Nerve decompression- is performed by releasing the deep transverse metatarsal ligament. – this requires a small cut from between the webspace of the 3rd and 4th digits. The ligament above the nerve is cut to allow the nerve to expand. Although this has little complications and feeling remains in your foot – the pain may not go away. Usually if the surgeon observes the nerve as very thick they will just cut it out.
*** The nerve was excised in 46 of the 69 cases; the nerve was preserved in 23 cases with release of the deep transverse metatarsal ligament. Total relief of symptoms was appreciated in all but one from each group. Thus results were almost 100% successful after surgery***
Unproven Surgical options
Cryogenic Neuroablation- this is a minimally invasive procedure that freezes the nerve at -50 to -70 degrees celsius- the results are not permanent and the procedure is unproven with research.
Complications of Surgery
Most Common in descending order
1) Stump neuroma – caused by not resecting the nerve proximal enough, incomplete excision, or tethering of the nerve to the plantar aspect of the metatarsophalangeal joint or other structures.
2) One study found that 54% of the time there is a tarsal tunnel irritation at the proximal tibial nerve as well & this is why the surgery did not work.
3) Damage to the digital arteries- This occurs almost 30% of the time according to some studies- although this almost always leads to no ill effects due to formation of collateral vessels to compensate.
4) Hammertoe formation- the toes can splay if the deep transverse inter tarsal ligament required resection
Keloid formation, complex regional pain syndrome.