CLINICAL FEATURES :
Most often, this nerve compression manifests as the onset of severe pain beneath and between the toes.
These pains are often experienced as electric shocks, they may radiate towards the tips of the toes or up towards the ankle. They are generally triggered by walking or prolonged standing, especially if you wear tight shoes.
During a painful episode, removing your shoes and massaging your foot can help alleviate the pain. A tingling sensation or a decrease in sensitivity between the toes is also possible.
It is possible to have multiple Morton’s neuromas on the same foot or to have concurrent involvement of both feet.
During your examination, your surgeon will seek to locate your pain. They will also use specific tests to pinpoint the Morton’s neuroma(s). They may also look for a decrease in sensitivity between the toes.
An ultrasound or MRI may be ordered by your physician or surgeon to visualize the swelling of the nerve or its compression by a neighboring structure. X-rays of the foot are frequently performed to rule out other bone or joint pathologies.
These examinations can also be used to search for pathologies often associated with Morton’s neuroma or to distinguish it from other diseases with similar clinical signs.
TREATMENT OPTIONS :
Firstly, it is recommended to adjust your footwear by wearing shoes with a wide toe box that do not compress the front of the foot and to avoid high-heeled shoes.
Orthopedic insoles (made by a podiatrist) to be worn systematically in your shoes and tailored to your morphology may be prescribed. Their purpose is to reduce repeated pressure on the nerve and thus decrease its irritation.
One or more corticosteroid injections may be administered to decrease or eliminate signs of the condition. When the injection is effective, the relief obtained may be temporary or permanent.
Unfortunately, these treatments do not always control the pain associated with the condition and may be ineffective for some patients. Your surgeon may then suggest surgical treatment aimed at either freeing the intermetatarsal nerve (“neurolysis”) or removing it (“neurectomy”).
In cases where no treatment is undertaken, the pain tends to worsen, resulting in increasingly significant discomfort during walking and wearing shoes.
A preoperative consultation with an anesthesiologist is mandatory. During this consultation, the anesthesiologist will explain the modalities and possible choices of anesthesia tailored to the surgery and your health issues.
During this consultation, your current medication regimen will also be reviewed. New medications may be initiated, either before or after the surgery. The most commonly used ones include anticoagulants, antibiotics, analgesics, anti-inflammatories, etc. They naturally carry specific risks.
The operative anesthesia may be locoregional (wider anesthesia encompassing a segment of the limb, from the leg to the toes), spinal (anesthesia of the pelvis and limbs by puncturing between two vertebrae), or general anesthesia.
Blood transfusion is rare in this type of surgery where bleeding is very limited.
POSTOPERATIVE CARE :
Specific postoperative footwear is often prescribed according to your surgeon’s protocol.
The dressing is carefully applied during the surgery according to your surgeon’s habits and is usually not to be changed. However, if home care is provided, it is important to ensure the hygiene of your incision as long as the stitches are in place and it is not completely sealed.
Hand hygiene is crucial, and one should never touch the incision without washing hands. Always ensure that you have hand washing facilities or a bottle of hand sanitizer at home for the nurse who will perform your care. On average, care is scheduled for a duration of 15 days to one month.
Prevention of blood clots: The prescription of anticoagulant injections is sometimes considered based on the assessment of your health condition by the surgeon and the anesthesiologist.
Postoperative pain management for this type of condition generally poses few difficulties. Even though strong painkillers may be used immediately after surgery, returning home with simple painkillers is the norm.
Postoperative swelling (swelling of the foot and toes) is common in ankle and/or foot surgery and is usually not a complication. Managing swelling is essential not only to alleviate pain but also to improve the quality of healing. Thus, a certain period of rest, elevation, and the use of compression stockings or varicose vein stockings can be helpful. This swelling can last a long time (several weeks to several months) and usually does not cause any problems, although it may require temporarily adapting footwear.
A period of leave from work is generally necessary after surgery. Its duration is on average one month but depends on your professional activity and the surgical procedures performed.
Postoperative follow-up consultations: Your surgeon will conduct regular clinical, radiological, and biological checks, and the results will be incorporated into your medical record.
The (anonymous) data from your record may be used for studies and/or scientific communications or publications by your surgeon, in compliance with the JARDE law of March 2012 (Decree 2016-1537). In this case, specific consent will be requested by your surgeon and included in your record. Initial consultations focus on monitoring healing and local condition. Subsequent consultations involve monitoring the progress of the procedures performed and your functional recovery.
The implementation of possible functional rehabilitation and the validation of the return to work and sports will be done according to your surgeon’s protocol.
AFTER THE INTERVENTION ?
A surgical procedure is NEVER a trivial matter. Regardless of the precautions taken, there is no such thing as “zero risk.” When you decide to undergo surgery, you must be aware of this and weigh the risks against the expected benefits of the procedure (= benefit/risk balance).
Despite the skills of your surgeon and the team caring for you, unfortunately, every treatment carries a risk of failure. This failure can range from the reappearance of symptoms to their worsening or other more significant risks. These risks may be due to chance, bad luck, but may also be exacerbated by health issues specific to you (known or unknown, local or general).
It is impossible to present here all possible complications, but we have listed below the most common or serious complications that may sometimes occur in your condition.