Patients typically experience burning, sharp, or shooting pain in the ball of the foot, which may spread into the nearby toes. Some describe tingling, numbness, or the sensation of walking on a pebble or folded sock. Symptoms are often triggered or worsened by tight, narrow, or high-heeled shoes and prolonged walking or standing, and may improve with rest or removing footwear.
When non-surgical options such as activity modification, shoe changes, orthotics, and corticosteroid injections fail (in about 1/3 of patients), surgery may provide significant relief.1,2
The Procedure
Morton’s neuroma excision is a surgical procedure that removes the affected segment of the irritated nerve to relieve pain. The surgery can be performed through an incision on the top (dorsal approach) or bottom (plantar approach) of the foot, depending on surgeon preference and patient-specific factors:
● Dorsal approach: An incision is made on the top of the foot and a small ligament is released to expose the nerve, which is then carefully removed.
This approach is commonly preferred because it avoids a scar on the sole of the foot and generally allows easier wound care and earlier return to walking.
● Plantar approach: An incision is made on the sole of the foot directly over the neuroma to provide direct access. This approach is typically reserved for large, recurrent, or revision cases and may be associated with more noticeable scarring and a slower return to full weight-bearing. 3
In selected cases, minimally invasive techniques may be used to access or decompress the nerve through smaller incisions. Regardless of the approach, removing the nerve eliminates the source of pain but may result in permanent numbness in the web space between the affected toes, which most patients tolerate well.4
Risks and Complications
Morton’s neuroma excision is generally associated with good outcomes; however, as with any surgery, complications can occur. The most common ones consist of:
● Numbness (≈ 72%): loss of sensation between affected toes, usually well tolerated
● Stump neuroma formation (3–8%): painful regrowth or irritation of the cut end of the nerve which may cause recurrent pain
● Hypertrophic scar (3%–11%): thickened or hardened scar tissue at incision site, more common with the plantar approach
● Need for reoperation (< 5%): due to pain recurrence or unresolved symptoms 1,4-6
As for other surgeries, general risks related to surgery and anesthesia may include infection and bleeding (<3%)5, blood clots, allergic reactions, cardiopulmonary complications, and wound-healing issues. Any other general surgical and anesthesia-related risks will be discussed with you prior to surgery if applicable.
What to Expect
Before surgery, your surgeon will examine your foot and review imaging or diagnostic tests if needed to confirm the diagnosis. Morton’s neuroma excision is usually performed under regional anesthesia (such as a nerve block), sometimes with sedation, or under general anesthesia, often depending on patient-specific factors.7 After surgery, your foot will be dressed and protected in a postoperative shoe, and pain is usually managed with acetaminophen and anti-inflammatory medications.
Your Recovery
Most patients go home the same day as Morton’s neuroma excision and are allowed to walk immediately in a protective postoperative shoe. Keeping the foot elevated during the first one to two weeks helps reduce swelling and promote healing, and stitches are typically removed after about two weeks.
Patients usually transition back to regular footwear and return to desk work or light daily activities within the first month, while more physically demanding activities such as recreational activities and sports are commonly resumed by 2 to 3 months. Full recovery then continues over the first year and, by 6 to 12 months after the procedure, most patients report significant pain relief and high satisfaction.8
Follow-up visits with your surgeon help confirm proper healing, address any early issues, and guide you safely through each stage of recovery.
References
Cooper MT. Common Painful Foot and Ankle Conditions: A Review. JAMA. 2023;330(23):2285-2294. doi:10.1001/jama.2023.23906
Mak MS, Chowdhury R, Johnson R. Morton's neuroma: review of anatomy, pathomechanism, and imaging. Clin Radiol. 2021;76(3):235.e15-235.e23. doi:10.1016/j.crad.2020.10.006
Xu W, Zhang N, Li Z, et al. Plantar and dorsal approaches for excision of morton's neuroma: a comparison study. BMC Musculoskelet Disord. 2022;23(1):898. Published 2022 Oct 6. doi:10.1186/s12891-022-05858-w
Kasparek M, Schneider W. Surgical treatment of Morton's neuroma: clinical results after open excision. Int Orthop. 2013;37(9):1857-1861. doi:10.1007/s00264-013-2002-6
Akermark C, Crone H, Skoog A, Weidenhielm L. A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton's neuroma. Foot Ankle Int. 2013;34(9):1198-1204. doi:10.1177/1071100713484300
Nery C, Raduan F, Del Buono A, Asaumi ID, Maffulli N. Plantar approach for excision of a Morton neuroma: a long-term follow-up study. J Bone Joint Surg Am. 2012;94(7):654-658. doi:10.2106/JBJS.K.00122
Sharrow CM, Elmore B. Anesthesia for the Patient Undergoing Foot and Ankle Surgery. Clin Sports Med. 2022;41(2):263-280. doi:10.1016/j.csm.2021.11.010
Faraj AA, Hosur A. The outcome after using two different approaches for excision of Morton's neuroma. Chin Med J (Engl). 2010;123(16):2195-2198.
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