Background Information:

What are the other Names for the Procedure?

• Decompression Surgery for Morton’s Neuroma
• Morton’s Neuroma Surgical Removal
• Neurectomy for Morton’s Neuroma

What is the Morton’s Neuroma Removal surgical procedure?

• Morton's neuroma is a painful clinical condition caused by the thickening of tissue surrounding a nerve in the foot, most commonly, between the third and fourth toes. This causes pain and discomfort in the ball of the foot
• Morton Neuroma Removal Surgery is a procedure that involves removing the Morton’s neuroma

What part of the Body does the Procedure involve?

Morton’s Neuroma Removal Surgery involves the nerve and the surrounding ligament and tissues between the toes of one or both the feet.

Why is the Morton’s Neuroma Removal surgical procedure Performed?

A Morton’s Neuroma Removal Surgery is performed for relieving pain associated with Morton’s neuroma, which can be severe in some individuals.

What are some Alternative Choices for the Procedure?

There are non-surgical options for the management of Morton’s neuroma that include:

• Use of special footwear with wide toes and/or cushion, and use of arch support
• Corticosteroid injection
• Injection of alcohol to numb the affected nerve

What are the Recent Advances in the Procedure?

Morton’s Neuroma Removal is a routine surgical procedure. No significant advances have occurred recently. 

What is the Cost of performing the Morton’s Neuroma Removal surgical procedure?

The cost of Morton’s Neuroma Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Morton’s Neuroma Removal surgery on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://bunionsurgeryny.com/procedures/foot-neuroma-surgery-mortons-neuroma/ (accessed on 06/23/2016)

Prior to Morton’s Neuroma Removal surgical procedure:

How is the Morton’s Neuroma Removal surgical procedure Performed?

Surgery for Morton’s Neuroma is commonly performed under local or regional anesthesia, in the following manner:

• The surgeon approaches the nerve by making an incision on either the top or the bottom of the foot on the skin overlying the affected metatarsal space (space between the metatarsal bones of the foot)
• The surgeon may then perform one of the following procedures:
  • The metatarsal ligament (a fibrous tissue in the metatarsal space that encloses the nerve) may be cut, so as to relieve pressure on the nerve and reduce symptoms
  • The affected nerve neuroma is removed
• The skin incision is sutured

Where is the Procedure Performed?

A Morton’s Neuroma Removal procedure is usually performed in an out-patient surgery center facility, a physician’s clinic/office, an emergency room, or at a hospital.

Who Performs the Procedure?

An orthopedic surgeon or a podiatrist performs a Morton’s Neuroma Removal Surgery.

How long will the Procedure take?

Surgery for Morton’s Neuroma may take a few minutes to up to an hour to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Morton’s Neuroma Removal Surgery and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• If the patient is hyperthyroid, this condition will need to be treated with drugs, before the surgery is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Local anesthesia may be used at the time of surgery to reduce pain following the procedure. Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for at least 4-6 weeks, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 4 hours prior to the surgical procedure, depending on when the procedure is arranged. Please discuss this with the medical team at your hospital
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Morton’s Neuroma Removal surgical procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Morton’s Neuroma Removal surgical procedure?

Before Morton’s Neuroma Removal procedure, the patient has to undergo certain tests such as:

• Routine blood and urine analysis
• X-ray of the foot

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Moron’s Neuroma Removal Surgery?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Morton’s Neuroma Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is commonly used for Morton’s Neuroma Removal Surgery. General anesthesia by injection and inhalation may rarely be administered for this procedure.

How much Blood will you lose, during the Procedure?

There is hardly any blood loss associated with a Morton’s Neuroma Removal surgical procedure.

What are the possible Risks and Complications during the Morton’s Neuroma Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The specific risks or complications that may arise during the Morton’s Neuroma Removal Surgery are:

• Anesthetic complications
• Excessive bleeding
• Infection surrounding the surgical wound

What Post-Operative Care is needed at the Healthcare Facility after the Morton’s Neuroma Removal surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Morton’s Neuroma Removal surgical procedure:

What are the possible Risks and Complications after the Morton’s Neuroma Removal surgical procedure?

The possible risks and complications that may arise after Morton’s Neuroma Removal Surgery include:

• Excessive bleeding
• Infection in the surgical wound
• Numbness within the toes due to nerve damage

What is the Prognosis after the Surgery?

A complete recovery from Morton’s Neuroma Removal surgical procedure is usually achieved, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain and swelling within the surgical wound
• Bleeding or fluid drainage from the surgical wound
• Signs of an infection
• Dizziness
• Muscle aches, headaches
• Feeling sick, fever
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Morton’s Neuroma Removal surgical procedure?

At home, the following post-operative care is recommended, after a Morton’s Neuroma Removal surgical procedure:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Use special footwear as advised by the physician, following the procedure
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with unscented soap
• Apply nonprescription antibiotic ointment to the surgical wound and replace the dressings regularly
• Keep the foot elevated while resting to prevent the formation of blood clots and reduce the possibility of swelling
• Complete the course of prescribed medication as advised by your physician
• Take antibiotic medication to help combat or prevent infection, under the physician’s advise
• Avoid taking nonprescription medications, such as aspirin.  However, individuals may take acetaminophen to relieve pain

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 3 weeks to fully recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Morton’s Neuroma Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, a physician’s office/clinic, an emergency room, or a hospital
• An anesthesiologist (if anesthesia was administered)
• Orthopedic surgeon or a podiatrist
• The pathologist who examines the tissue and makes a definitive diagnosis.

The patient is advised to inquire and confirm the type of billing, before the Morton’s Neuroma Removal Surgery is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA