LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Morton’s Neuroma Surgery

How the surgery is carried out

It is a day-case procedure. The operation is done under a general anaesthesia and an added local anaesthetic injection in the foot to numb it for after surgery. The operation itself involves a 2 cm incision on the top of the foot just between the toes over the painful neuroma. The procedure then involves carefully removing the neuroma from between the toes. Dissolvable skin stitches are used.

What to expect immediately after surgery in hospital

Your foot will be bandaged, numb and pain free. You will see a physiotherapist who will advise on mobility in a padded stiff shoe supplied. You will be discharged only when comfortable and given an out-patient appointment and pain-killers as required.

Recovery in first few weeks after surgery

  • Elevate you foot as often and as much as possible to reduce swelling.
  • Mobilise as instructed, but only for necessity indoors and outdoors.
  • Some blood ooze can be expected in the bandage, if worried contact the Consultants clinic.
  • Take pain-killers as prescribed.

Post-operative clinic schedule

  • 2 weeks - Remove bandage, clinical examination
  • 6 weeks - Remove shoe, clinical examination
  • 12 weeks - Clinical examination, discharge

When I start to walk?

  • 0-6 weeks - Full weight-bear in hospital shoe
  • > 6 weeks - Full weight-bear in normal shoes

How do I wash and shower?

In the first 2 weeks keep the bandaging totally dry. You may shower with a waterproof cover over the foot. After 2 weeks you can only shower if the wound is healed but gently dab the wound dry.

How can I look after the wound?

Once out of bandaging, do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore you need to see your Consultant to ensure there is no infection present. Your physiotherapist may advise on wound massage when it has healed. 

Physiotherapy and Rehabilitation

Your physiotherapist will guide you through the stages of rehabilitation including toe mobilisation exercises, swelling reduction and reducing muscle tightness. It is important to adhere to advice given. 

When can I start to drive again?

DVLA states it is the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop. This will take at least 4-6 weeks. Click here to read DVLA guidance.

When can I work?

This is very individual and job-dependent. Below is a guide:

  • Sedentary 2 weeks
  • Manual labour 6 weeks

What long-term outcome can I expect after surgery?

Excellent pain relief once the wound has healed, which can take 2-4 weeks. Good level of activity and sports by 3 months. It will take up to 6 months to be fully recovered. It is an operation with good patient satisfaction in up to 90% of cases. Mild swelling can persist in the foot for up to a year. Isolated toe numbness will likely persist as the nerve has been removed but is rarely troublesome. 

What are the risks? 

Any operation carries a risk. Below is a guide to some risks potentially encountered. It is the surgeons duty to fully inform you of possible risks. Mr Roche will ensure this is always done so patients can make safe and informed choices about their operation.

Infection

If this happens, it is usually simply treated with antibiotics. Significant consequences from infection are very rare but can be dealt with. Risk is around 1%.

Recurrence of the neuroma

Unfortunately symptoms can persist in some patients (estimated 10-30%). If this is the case then further treatment can be discussed. This can involve repeated injections or even further surgery that may only be successful in 60-70%. 

Toe stiffness

In the early post-operative phase, swelling and stiffness is quite common but generally improves with time. You can reduce the stiffness by performing regular exercises.

Deep Vein Thrombosis

Symptomatic clot formation in the leg is unusual after foot surgery (<3%). Whether treatment to prevent clot is needed can be discussed with your surgeon. There is no consensus amongst UK Orthopaedic surgeons as to whether preventative medicine is needed.

Important last note

This document is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road