Friday, April 12, 2024

Morton’s Neuroma Surgery Recovery Tips

What Happens After The Surgery

Mortons neuroma surgery recovery part 5

WEEKS 0-2You will have post operative bandaging on your foot but will be able to walk fully weight-bearing in a post operative sandal. Although crutches maybe used they are not necessarily needed. In this time it is important to keep the leg elevated above heart level as frequently as possible although you should not be confined to bed.You can go to work after a few days if your work is sedentary and desk based and your commute is not difficult.

WEEKS 2-6You will be seen at the two week mark for removal of the bandaging and a wound inspection. At this stage it is likely that you will be able to graduate to normal shoes although a pair of trainers or comfortable and wide fitting shoes are advised.There would be residual pain and swelling that would be ongoing but gradually improving.

WEEKS 6-12The postoperative pain and swelling will slowly resolve in this period and you are able to return to most of your day to day activities although return to sports or high impact activities may only be possible towards the end of this period.

What Does Surgery Involve

The operation is performed as a day surgical procedure. It can be done under local anaesthetic although if you are fit and well we do prefer a short general anaesthetic for the procedure. The operation takes between 20-30 mins.

Intraoperative photos showing the exposure and incision required to explore the webspace for a neuroma.

Example of a neuroma after excision.

What Is An Excision Of Mortons Nueroma

If you sometimes feel that you are walking on a marble, and you have persistent pain in the ball of your foot, you may have a condition called Mortons neuroma. A neuroma is a benign tumor of a nerve. Mortons neuroma is not actually a tumor, but a thickening of the tissue that surrounds the digital nerve leading to the toes .

Mortons neuroma most frequently develops between the third and fourth toes, usually in response to irritation, trauma, or excessive pressure. The constant pressure on the nerves that lead to the toes results in the thickening of the tissue that surrounds said nerve, causing Mortons neuroma. Women who frequently wear high-heeled or narrow shoes experience Mortons neuroma due to the compression of the toes and pressure of the ball of the foot. High-impact sports and activities such as running may also cause Mortons neuroma.

The incidence of Mortons neuroma is 8 to 10 times greater in women than in men.

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What Are The Risks Of Surgery

INFECTION-

This can occasionally occurs as with any operation. Antibiotic therapy or occasionally surgery to wash and clean the wound may be necessary.

NUMBNESS or NERVE INJURY-

This is an expected outcome of the surgery as the nerve that is supplying sensation to the toes is being removed. In practice the area of numbness is small and not of any consequence. Occasionally however the whole toe can go numb.

LACK OF BENEFIT or RECURRENCE

In a proportion of patients the pain may not improve or may return after a period. This may be cause the initial pain pathology was not the nerve or that the nerve has re-grown. Fortunately this happens in around 5% or less if the correct diagnosis has been made.

COMPLEX REGIONAL PAIN SYNDROME –

This is a rare complication that can result in post op pain and skin colour changes in the whole of the foot and sometimes the entire lower leg. It occurs in less than 0.5% but can result in a poor outcome and prolonged recovery.

Treating Morton’s Neuroma: Surgery To Save The Nerve Or Remove The Nerve

Pin on Running

Morton’s neuroma is a thickening of the metatarsal nerves. It causes acute shooting, burning or stabbing pain in the metatarsus and in the toes. The pain is so severe that patients will only experience temporary relief by sitting down or taking off their shoes. After taking strain off the foot, pain quickly subsides. Formication or a feeling of numbness in the toes are symptoms of Morton’s neuroma.

Morton’s neuroma is a very common result of splayfoot, sometimes in combination with hallux valgus. Women are four times more likely to develop Morton’s neuroma than men. This is probably related to footwear: High heels and pointed toes cause a lot of pressure on the front arch of the foot, increasing the risk of developing splayfoot. Splayfoot changes the position of the metatarsal bones and increases pressure on the nerves running along the sole of the foot.

But even men primarily runners training a lot can develop it. Morton’s neuroma is most likely to occur between the 3rd and 4th toe, and somewhat less likely to occur between the 2nd and 3rd toe.

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Massaging The Painful Area

For me, this is the first thing I do, and I massage my foot daily. Sometimes I fear touching it when it is not paining. But theres always that little urge to touch it. In the beginning, when the neuroma pain is just starting it is often hard to pinpoint the exact location of the pain.

Especially if you havent had a thorough diagnosis by the doctor. Your pain will present as a general, localized ball of foot pain. In this case, you can massage the whole area. It will help ease the pain.

When you know where exactly your neuroma is located, it helps a great deal to touch directly there and massage. My youngest daughter discovered my spot and always helps me when Im in pain. It is nice to have someone massage you, but you can do it yourself.

  • Locate your neuroma spot between the toes
  • Hold it between your index finger and thumb and press gently, repeatedly.
  • You can even move your fingers back and forth along the length of your neuroma. With this, you may feel what I like to call sweet pain because though it is painful, you just want to keep doing it!

A professional foot massage also helps ease the overall pressure off your feet. Please give your feet a treat once in a while and get a masseuse or even a foot spa treatment.

Who Qualifies For Morton’s Neuroma Surgery

In order to fully assess Morton’s neuroma, we need current MRI images. These images are then used to decide together with you if surgery is necessary and what type of surgery is best in your specific case.

In the early stages, Morton’s neuroma can often be treated conservatively, using insoles and performing foot exercises. If the personal quality of life has been reduced and pain is severe, and if conservative treatment is unsuccessful, surgery is an option. If the size is less than 0.8 cm, surgery can be used to save the nerve . If the Morton’s neuroma swelling is too severe, the nerve will need to be removed .

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Recovering From Neuroma Surgery

Recovery from neuroma surgery depends on the kind of procedure performed. In procedures performed from the top of the foot, patients can expect a recovery time of three to four weeks. During that time, they need to rest the foot higher than the heart and keep walking to a minimum. Walking requires a postoperative shoe with a boxy shape and rigid sole. Patients can typically return to work when they can comfortably wear a normal shoe.

In surgeries in the plantar region, recovery typically takes longer. Because the incision is on the bottom of the foot, patients must use crutches and avoid putting pressure on the sole of the foot for three weeks or more. For this reason, many surgeons prefer to perform surgery using an incision on the top of the foot.

In either situation, dressings are changed at the first post-op follow-up and stitches are typically removed ten to 14 days after surgery. Until the stitches are out, the foot should be kept dry and clean to avoid the risk of infection. Depending on the minimally invasive techniques that your podiatrist uses, your recovery time and post-op care can be greatly reduced. Your doctor will give you an idea of what to expect.

What Are The Alternatives To Surgery

Mortons Neuroma Post Op Recovery Part 2

Surgery is not always required. Treatment alternatives include orthotics , change of footwear or avoidance of pain inducing activity and also injections of cortisone in and around the painful nerve.

It is also important that one has established confidently that the thickened nerve or neuroma really is the cause of the pain. This is because studies have shown that nearly half of the population may have a nerve that is enlarged on imaging scans but is not causing any symptoms.

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How Is Mortons Neuroma Excision Performed

Before the surgery, you may be given some form of sedative anesthesia, and a local anesthetic will be injected into the affected area of the foot. IV sedation requires the assistance of an anesthesiologist to administer the medication and monitor your vital signs.

To remove a neuroma, a small incision is made in the web space between the two affected toes. Traditionally, the incision has been done on the dorsal side, or top, of the foot, although it can be done using a plantar approach .

Your surgeon will continue the incision deeper between the metatarsals to locate the neuroma. The neuroma is dissected free of the nerve to which it is attached and excised. A portion of the involved nerve is also removed .

The wound may be closed with an absorbable suture or with stitches, and the foot is wrapped in a compressive dressing. The dressing holds the foot securely in place, much like a cast, to allow healing.

The dressing should be kept on until the first post-operative office visit, which is usually 10 to 12 days after surgery, when your surgeon will change or remove it.

Other types of procedures for Mortons neuroma include:

Procedures For Resistant Post Mortons Neuroma Surgery Pain

  • Platelet Rich Plasma injections are very helpful for their effect on local inflammation which is frequently present in painful stump neuromas. Careful attention should be given to identify bursitis or synovitis both of which respond well to Platelet rich plasma injections. We routinely perform Platelet Rich Plasma Injections for all of our post Mortons neuroma surgery patients who come with post surgery pain. We combine this with an ultrasound guided ablation procedure for best rests.
  • Ablation procedures. Ablation procedures done under ultrasound can be very effective in alleviating post Mortons neuroma surgical pain, assuming that one can accurately localize the source of the pain.
  • This usually requires a diagnostic local anesthetic injection done under ultrasound and preferably with nerve stimulator guidance beforehand, to ensure that the source of the pain can be accurately localized. This diagnostic injection also tests that the pain is responsive to local anesthetic which is an indication that the pain will respond well to an ablation procedure.

    Even when an ablation procedure is done after a positive diagnostic local anesthetic injection an accurate prediction of the outcome is difficult to make given the individual variability of exact cause of the pain.

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    How Long Does It Take To Recover

    After your surgery, your foot and ankle will be bandaged, and these bandages remain on for two weeks. You will be shown how to walk in your special orthopaedic shoe, which protects your foot. Most patients are able to go home on the same day as their operation.

    You should try to rest your foot, keeping as much weight off it as possible, and keeping it raised above the level of your heart whenever you can, especially in the first week after your operation. Once this week has passed, your pain levels should have reduced greatly. Depending on your job, you may be able to return to work during the second week after your operation.

    Around two to three weeks on, you can return to sporting activity, starting with low impact exercise and gradually increasing your activity level.

    When Can I Start To Walk

    Foot Neuroma Surgery NYC (Morton

    Your surgeon will be able to advise you about the type of footwear you should use and how quickly you will recover. Below is a guide to what may be advised:

    • 0-6 weeks: you will be able to fully bear your weight in a hospital shoe
    • After six weeks: you will be able to fully bear your weight in your own shoes

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    When Can I Start My Routine

    WORK- we recommend between a few days to two weeks off work depending on how physical your work is and what your commute to work is like.

    SPORTS- most sports can commence by 3 month post op although some low impact activities such as cycling may be possible as early as 6 weeks.

    SHOWER- you can get you foot wet after the two week visit when the bandaging is removed and full wound healing confirmed. Before this you need to shower with protective covering to waterproof the dressings and prevent it from getting wet.

    How Long Is Recovery After Mortons Neuroma Surgery

    Recovery from Mortons neuroma surgery takes up to 3 months in total. The first two weeks are about keeping your wound clean, your foot elevated to reduce swelling, and general rest. After this, you can commence Physical Therapy for 6-12 weeks. This involves massage, strengthening, and mobility exercise. Custom Orthotics may be recommended to address any biomechanical causes of the neuroma to reduce the risk of it returning.

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    Why Might I Need Mortons Neuroma Surgery

    If you are suffering from Mortons neuroma, also known as Mortons metatarsalgia, a condition where a nerve in the foot becomes irritated and extremely painful, you may need Mortons neuroma surgery. It is normally found in the nerve between the third and fourth toes, but the second and third toes can be afflicted too. It may involve a single foot or both feet. Symptoms include:

    • Discomfort and a numb feeling between the toes
    • Extreme pain in the ball of the foot, as if a stone is digging into the foot
    • Walking exacerbates the pain, particularly if your shoes do not fit properly
    • Pain may travel along the foot or move up the leg. Going barefoot may improve this

    When Can I Go Back To Work After Mortons Neuroma Surgery

    Morton’s Neuroma Healed with Nerve Surgery

    This will depend on the type of surgery you have opted for. If you chose the nerve decompression procedure, you can expect to get back to work almost immediately with comfortable shoes.

    With neurectomy, the healing process can take much longer. This will again vary from person to person. You can expect to go back to work in about 4 weeks.

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    Symptoms And Signs Of Stump Neuromas

    The most common sign associated with recurrent Mortons neuroma is exquisite local tenderness at the level of the stump neuroma. The pain is usually nerve pain like in nature, with the patient complaining of sharp, burning, or electrical type pain. This is usually located about 1 to 1½ centimeters proximal to the metatarsophalangeal joint. Occasionally, patients will complain of a nodule or lump in the previously operated web space associated with scar tissue or bursitis.

    Symptoms are typically aggravated by weight bearing, walking, and wearing certain shoes

    Tinels sign may be elicited upon direct dorsal or more commonly plantar palpation of the recurrent lesion. This finding, however, need not be present in all cases. Similarly, the web space may be numb or dull to touch.

    The key finding is the reproduction of symptoms upon direct, deep palpation of the stump neuroma. The pain can be very debilitating and, at the least, often makes the patient alter his/her shoe gear if not lifestyle.

    All About Mortons Neuroma Surgery

    When all other measures have failed to relieve pain, open surgery may be necessary to remove the neuroma. It is critical that Mortons neuroma surgery be performed by surgeons who have considerable expertise and experience in this surgery because in some cases, Mortons neuroma surgery can result in increased foot pain or even the return of the neuroma.

    With the most common approach, your surgeon will make a small incision on the top of your foot over the third web space. After dissecting through the tissue, the transverse metatarsal ligament is cut, to take pressure off the nerve and to allow the surgeon access to the neuroma. In most situations, the nerve itself with the resulting neuroma is removed. The incision is closed, and the patient is taken to recovery. With this approach, you can bear weight on your foot post-operatively, however it still takes 3-4 weeks to fully recover.

    Other less frequent approaches include the plantar approach With the plantar approach, the surgeon has less tissue to dissect, and he is able to preserve the ligament, leading to better foot stability in the long term, but recovery is slow and you are unable to bear weight for 2 to 3 weeks until the sutures are removed. It can take 4-6 months of painful recovery to fully recover from a plantar approach Mortons neuroma surgery.

    Surgical treatment of Mortons neuroma is can be effective when perfumed by an experienced practitioner, but it comes at the cost of some risks and possible side effects.

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    What Are The Risks

    Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:

    Infection: The chance of infection is around 1% and can usually be treated with antibiotics. Serious problems caused by infection are very rare and can be treated

    Recurrence of the neuroma: Unfortunately 10-30% of patients still experience symptoms. If this is the case then further treatment such as injections or further surgery can be discussed

    Toe stiffness: The toe can remain a little stiff but usually recovers over the course of rehabilitation and physiotherapy can help with this

    Deep Vein Thrombosis : You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT . However, DVT is fairly unusual after this type of surgery

    Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other peoples. Please contact us for advice if youre worried about any aspect of your health or recovery

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