A neuroma is an abnormality of a nerve that has been damaged either by trauma or as a result of an abnormality of foot function. The most common location of neuromas is in the ball of the foot. In this area the nerve can become pinched and inflamed by the abnormal movement of the bones in the ball of the foot.
As the condition progresses the nerve may become permanently damaged and surgical removal of the nerve may be necessary.
The surgical removal of forefoot neuromas is a relatively simple procedure. The surgery can be performed using a local anesthesia in the doctor's office or with intravenous anesthesia (twilight anesthesia) in an outpatient surgery center.
Following administration of anesthesia, a skin incision is made on the top of the foot in the location of the neuroma. This is most commonly in the area between the second and third toes or between the third and fourth toes. An alternative surgical approach is to place the skin incision on the bottom of the foot in the location of the neuroma. Most surgeons perfer to make the skin incision on the top of the foot for several reasons. If the skin incision is placed on the bottom of the foot the patient may be required to use crutches for up to three weeks. Additionally, it takes longer for the skin on the bottom of the foot to heal. In the event that a thicken or irregular scar forms during healing, it may cause pain while walking. When the incision is made on the top of the foot the neuroma is easily found between the long bones (metatarsals) behind the toes. After the nerve is identified it is cut and removed. Once the surgery is completed a gauze dressing is applied. This bandage stays in place until the surgeon sees the patient on their first post-operative visit. On the first post-operative visit the surgical site is inspected and a new dressing is applied. The sutures are removed in 10 – 14 days following the surgery. During this period of time the foot must remain dry to reduce the risk of infection. The patient should limit their activities and keep their foot elevated above the heart as much as possible. A post-operative shoe is worn which allows the patient to do limited walking. The patient should not walk with out the post-operative shoe. Once the sutures have been removed the patient may bath the foot and attempt to wear a roomy stiff-soled walking shoe. It generally takes three weeks from the time of surgery before the walking shoe can be worn comfortably.
The time required to be off from work will depend upon the type of work being performed and the type of shoe that must be worn. If the patient can work with their foot propped up and elevated with limited walking they may be able to return to work within a week of surgery. It is generally recommended that the patient not return to work until they can wear a normal shoe comfortable. Patients who have jobs that require prolonged standing, walking, kneeling or climbing may be off from work for as long as four to six weeks.
The surgery has an over all high rate of success, however, as with any surgery complications can occur. Possible complications include infection, excessive swelling, and delays in healing or continued pain. Also when a nerve is cut there is a small possibility that the nerve may grow abnormally producing a stump neuroma. If the patient walks on the foot more than what is recommended excessive swelling can cause bleeding or scaring that may result in continued pain and delays in healing.
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