What is it?
In between the metatarsal bones and the toes on the bottom of the foot a sensory nerve is pinched. As the nerve gets pinched, the nerve gets swollen, and we call this a neuroma.
If all conservative treatment measures have been attempted and or patient does not wish conservative management surgical excision may be performed.
By removing the nerve, the swelling of the nerve or the neuroma is removed as well.
You will be numb between the toes permanently after this surgery, since the nerve is no longer there however there will be no abnormality in the movement of the toes as this is a sensory nerve and not a motor nerve.
The results of neuroma surgery are good, but the nerve can grow back forming a stump neuroma, and unfortunately the recurrence rate of symptoms after removal of a neuroma is about 20%.
General Recovery Facts
- You can expect mild pain for the first 3-5 days.
- You are not allowed to walk on the foot for the first week or so as this may cause the wound to open.
- You may use crutches, walker or rollabout/knee scooter if needed.
- You may drive by about 10 days if it is your right foot, and 14 days if it is your left foot.
- A lot now depends on whether additional surgery is performed with the toes for other deformities.
- During recovery you may walk without the surgical shoe once the wound has healed.
- You can start doing light exercise at about 4 weeks.
- You will be able to wear a sneaker type shoe at about 6 weeks.
- The toes will remain puffy and swollen for 3-6 months.
- An orthotic arch support MAY be important but NOT necessary for your recovery. You will be referred to one of my orthotists following a computer analysis of the pressure of the foot, and a customised orthotic will be made for your foot (not an off-the-shelf product) to be worn whilst recovering from surgery.
Specific post-operative recovery
- Foot is wrapped in bulky bandage and surgical shoe.
- Ice, Elevate the leg, and take pain medication as prescribed regularly.
- Expect numbness in foot 12-24 hours then pain.
- Blood drainage through bandage is expected, do not panic unless continuous bleeding occurs.
- Do not change bandage under any circumstances, contact my rooms before any such thoughts cross your mind.
- You may walk on the foot if comfortable.
- Moderate pain -continue pain medication.
- Ice, elevate as much as possible.
- Continue heel walking in surgical shoe.
- May drive in surgical shoe.
- Do not change dressing unless instructed.
- First follow-up in the office.
- Wound is exposed by my dressing Sister.
- Dressing changes, toes may be strapped.
- Wound therapy with micropore and Bactroban dressings for the next 4 weeks is to be commenced.
- Massage of the scar on the top of the foot is important 3 times a day for 10 minutes at a time in order to prevent contracture of the scar which may lift the toes or cause sensitivity of the scar.
- This massage should continue for about 1 month.
- Physical therapy may be useful for about 1 month.
- Second followup at 6 weeks.
- Continue scar therapy and range of motion exercises.
- Light nonimpact exercise may commence to pain and swelling at 4 weeks.
- Expect swelling in the foot for about 6 to 9 months.
- Pictures taken for comparison to preoperative state.
- Functional outcome score taken.
- Patient is usually discharged at this point.