Neuroma surgery options for the leg, ankle and foot

When surgery is considered

Surgery is generally considered for a well-defined neuroma that has kept causing pain after a fair trial of non-surgical care, or that cannot be accommodated by changes to shoes, padding or a prosthesis. Careful patient selection is the foundation of good outcomes.^[4] Before surgery your clinician confirms that the nerve is the source, typically with examination, imaging, and sometimes a diagnostic injection arranged with another specialist. See painful neuroma of the foot, ankle and leg. Morton’s neuroma, a common neuroma between the toes, has its own page: Morton’s neuroma surgery.

The main techniques

Excision with relocation (passive techniques)

The neuroma is removed and the cut nerve end is placed away from areas of pressure and movement, for example within muscle or bone, or covered. Doctors sometimes call these “passive” techniques. Despite the label, they give positive results in a majority of patients treated.^[1]

Reconstruction with a graft

If both ends of the nerve can be found, the gap left after the neuroma is removed can be bridged with a nerve graft. In 12 people with painful lower-limb neuromas, a processed nerve allograft was used for reconstruction or for lengthening the nerve and moving it into muscle.^[5] See nerve grafting.

Giving the nerve a target (active techniques)

• Targeted muscle reinnervation (TMR) connects the cut nerve to a motor nerve branch of a nearby muscle. See targeted muscle reinnervation.
• Regenerative peripheral nerve interface (RPNI) wraps the nerve end in a small graft of muscle. See regenerative peripheral nerve interface.

What the studies show

• Overall. The 2022 meta-analysis of 30 studies found good results in 70% of treated neuromas (95% confidence interval 64% to 77%). In a post hoc analysis TMR (82%) did significantly better than neurectomy. The authors concluded that surgery achieves significant pain relief in most cases, and that TMR is promising.^[2]
• Pooled TMR and RPNI results. A review of 17 studies found neuroma pain improved in 75 to 100 percent of patients treated, with complication rates of 13% to 31%. Most studies were small, and only one was a randomized trial.^[6]
• Lower limb, long term. In 32 people who were followed for an average of 8.9 years after surgery for 48 lower-limb neuromas (mostly excision and implantation), average pain fell from 7.3 to 4.9 out of 10. Smoking and low mood were linked to worse outcomes.^[3]
• Processed allograft. In a registry of 21 people with upper-limb neuromas, pain improved in 80% of nerve reconstructions and meaningful sensation returned in 88%.^[7]

Recovery and expectations

The aim is meaningful improvement in pain, not a promise of none. Recovery takes months, and nerve fibres regrow slowly. After TMR or RPNI, some people have a short-term increase in pain before it settles.^[8] Wounds on the foot and leg can be slow to heal.

Risks

Risks include infection, wound-healing problems, bleeding, numbness, persistent pain, a new or recurrent neuroma, and the need for more surgery. See also revision nerve surgery when a first operation does not settle the problem.

Choosing among options

The choice depends on the nerve involved, whether both ends can be found, previous surgery, your general health and your goals. This page describes what has been studied. Dr. Ozturk performs this procedure for appropriate patients, and an evaluation is how to find out whether it fits your situation.

When to seek care

Consider an evaluation if a spot on your leg, ankle or foot is very tender or shoots with light touch, especially after an injury or operation, and it has lasted more than a few weeks.