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Thigh / Knee / Leg / Ankle / Foot - Failed Morton's Neuroma Surgery
A Morton’s neuroma is a painful condition due to compression of one or more of the common plantar digital nerves between the heads of the metatarsal bones by the transmetatarsal ligament. A neuroma is a painful structure that forms when a nerve is cut or severely crushed. The end of the nerve that is still attached to the spinal cord (the “upstream” end) will try and find its “downstream” counterpart and regrow, repairing the nerve. If the upstream or “live” end of the nerve is unable to complete this process for whatever reason, the end result if painful structure that forms on the upstream end known as a “neuroma.” A neuroma consists of a tangled ball of sensitive nerve fiber ends mixed with scar tissue. Although the condition is referred to as a “Morton’s neuroma,” this is actually a misnomer in the sense that the enlarged appearance of the affected nerve(s) represents a benign swelling of the nerve rather than a true neuroma.

The pain associated with a Morton’s neuroma affects the ball of the foot, typically the area just proximal to the second and third or third and fourth toes. The pain is usually quite localized and patients will often describe it as feeling like they are standing on a pebble or a nail. Some patients may also experience burning pain or numbness which radiates into the toes served by the affected nerve(s).

Most patients with the diagnosis of a Morton’s neuroma will be referred to either a podiatrist or possibly an orthopedic foot and ankle surgeon. Initial treatment consists of steroid injections and footwear modifications. If this fails, attempts to “kill” the nerve using alcohol sclerosis (injecting the nerve with alcohol) are usually the next step. Other modalities which involve burning or freezing the nerve(s) are also available. Surgery is typically reserved as a final option when all else fails. Unfortunately, due to the incorrect understanding of the primary problem as a neuroma rather than a compression neuropathy, the traditional surgical approach to treating a Morton’s neuroma has been to cut out the swollen part of the nerve and hope that this solves the problem.Ronald’s Story – Failed Morton’s Neuroma Surgery

Good data on the long-term efficacy of cutting out Morton’s neuromas is hard to come by, however, studies indicate that only about 50% of patients who undergo surgical removal of the swollen nerve report “excellent relief” of their pain at 10 years follow-up. In addition, as many as 35% of patients report unacceptable levels of post-surgical pain and often patients may experience much worse pain after surgery than they did before.treated correctly and that complications such as infection, etc., have been ruled out first.

Patients who continue to experience unacceptably high levels of pain are designated as having “failed Morton’s neuroma surgery.” Traditionally, there have been no good options for these patients. They will often undergo repeat surgery, often via incisions through the weight-bearing balls of the feet which causes scarring and loss of the fatty padding that cushions the metatarsal-phalangeal joints of the foot. Repeat surgery typically focuses on cutting out the new neuromas and hoping for the best. This approach is rarely successful and often leads to adjacent nerves being damaged and a downward pain spiral for the patient.

For patient who have never had surgery for a Morton’s neuroma, a better approach is to surgically decompress the nerve rather than cut it which avoids the possibility of formation of a true neuroma in the bottom of the patient’s foot. This approach is usually successful unless there has been significant blunt or penetrating trauma to the affected nerve(s).

For patient’s who have failed Morton’s neuroma surgery, there is now a very good surgical option to treat the pain. This novel approach involves making an incision in the non-weight bearing arch of the foot. The surgeon then identifies the injured nerves and disconnects them far enough back that they are no longer located in the weight bearing area of the foot. Nerve allografts are then sewn onto the ends of the native nerves which prevents the formation of another painful neuroma resulting in the elimination of the debilitating chronic pain associated with this problem. For patients who have failed Morton’s neuroma surgery, this surgical option can literally change their lives.
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