Morton’s neuroma surgery: options, recovery and results

When surgery is considered

Most people with Morton’s neuroma start with simple steps: roomy shoes, padding, orthotics, activity changes and, in selected cases, an injection.^[1] Surgery enters the conversation when pain persists despite a well-tried course of these measures, interferes with daily life, and the diagnosis is well supported. In a review of people treated with corticosteroid injections, nearly 30% eventually had surgery because of persistent pain.^[4] For the full stepwise approach, see Morton’s neuroma treatment, and for the condition itself, Morton’s neuroma.

The two main operations

Neurectomy (removing the nerve segment)

The surgeon removes the thickened part of the nerve between the toes. It can be done through an incision on the top of the foot (dorsal approach) or on the sole (plantar approach). Because the nerve that supplied feeling to the adjoining sides of two toes is removed, some numbness there is expected and is usually permanent.^[5]

The two approaches have different trade-offs:

• In a pooled analysis, scar tenderness was more common after the plantar approach (about 17%) than after the dorsal approach (about 6%). Reoperation and overall complication rates were not significantly different.^[6]
• In a single-center comparison of 37 people, satisfaction and function scores did not differ between the two approaches.^[7] A randomized trial included in a 2024 Cochrane review also found similar satisfaction, although the certainty of that evidence is low.^[8]

Neurolysis or decompression (releasing the nerve)

In this approach the surgeon divides the ligament that lies over the nerve between the metatarsal bones, and sometimes moves the nerve out of the way, without removing it. The aim is to relieve pressure while keeping the nerve’s feeling. A review of operations other than neurectomy found that after neurolysis, fewer people had ongoing nerve symptoms than after neurectomy. It also noted that minimally invasive decompression techniques had less reliable results, and that high-quality studies were limited, so it remains unclear whether these operations are better than neurectomy.^[2]

A small case series of 12 people who had the ligament released alone reported a drop in average pain scores from about 6.4 to 2 out of 10 after about a year, with no recurrent neuroma or lasting numbness. It is encouraging but short-term and small.^[9]

What studies show about results

A meta-analysis of 35 studies including 2,998 people compared three treatments:

The authors found that complication rates did not differ between the treatments, and that surgery, by either method, trended toward more complete pain relief than injection.^[3] These figures pool many studies of different designs and quality, and the people treated with each method were not necessarily the same. They show a general pattern, not what will happen to you.

Recovery

Recovery depends on the operation and on you. In general:

• First weeks: a protective post-operative shoe, keeping the foot elevated to control swelling, and keeping the dressing dry.
• Return to shoes and activity: gradual, over several weeks. Swelling can take a few months to settle fully.
• Numbness: expected in the adjoining sides of the two toes after neurectomy.
• Scar: may be tender for a while, especially on the sole.^[6]

Risks

All surgery carries risk. Risks discussed before neuroma surgery include infection and wound-healing problems, a thickened or sensitive scar, blood clots, and persistent pain. After neurectomy, the cut nerve end can form a new painful neuroma, called a stump neuroma. When that happens, a second operation may move the nerve end to a place where it isn’t pressed on when you walk.^[10,11] See revision nerve surgery.

Questions to ask before deciding

• How sure are we that a neuroma is causing my pain, and what else could it be?
• What non-surgical treatment have I tried, and is anything worth trying first?
• Which operation do you recommend for me, through which incision, and why?
• What numbness should I expect, and what is a realistic result?
• What will recovery mean for my shoes, work, driving and exercise?

When to seek care

Consider an evaluation if pain in the ball of your foot lasts more than a few weeks despite changing your shoes, or if pain has returned after neuroma surgery.