Surgery in percutaneous Morton syndrome

All about Morton’s neurosis: causes, symptoms and diagnosis

Morton’s neuroma is a ductal pathology. It is due to a compression of a digital-plantar nerve in a canal between the metatarsal heads. This syndrome causes extremely sharp pain in the forefoot. Patients with Morton’s neurosis usually complain of very acute, transient pain that occurs most of the time during walking, often pushing the patient to take off his or her shoes.

In most cases, the neurosis lies between the 3rd and 4th ray but can also sit between the 2nd and 3rd.

The symptoms

Morton’s syndrome is characterized by the presence of several symptoms alone or associated:

Sharp pain under the foot when walking (metatarsalgia)
Numbness of the toes (paresthesia)
A sensation of electric discharge in the toes
The need to take off your shoes to ease the pain

When one of these symptoms appears, it is important to consult a specialist of the foot and ankle in order to manage the condition prematurely and stop its evolution.

The diagnosis

Julien Lopez takes great care to adapt the treatment according to each case. In particular, it takes into account the type of deformation and its magnitude. In order to determine the most appropriate treatment, he systematically conducts a clinical examination followed by medical imaging examinations.

In the case of a Morton’s neurosis, the pain felt by the patient must be violent and localized precisely at the nerve level. The Mulder Test gives the diagnosis, it is a noticeable highlight during the transverse compression of the metatarsal palette.

To confirm the diagnosis, X-rays and ultrasound are often performed, much more reliable than MRI. Nevertheless, the diagnosis remains clinical and additional tests are not necessary.

The causes

The exact causes of the appearance of Morton’s neurosis are still poorly known.

It is said that nerve irritation caused by a succession of microtrauma and the wearing of narrow shoes can result in nerve compression.

Non-surgical treatment and percutaneous intervention for Morton

Depending on the case, Dr. Julien Lopez may refer his patients to non-surgical treatment or percutaneous surgery for Morton.

Non-surgical treatment

There are several possible non-surgical treatments for Morton’s neurosis before surgery:

Physiotherapy is one of the first-line treatments in the case of a Morton’s neurosis. The goal of this rehabilitation work is to relieve muscle tension contributing to nerve compression and to release the forefoot from the hindfoot. To do this, the physiotherapist performs massages and stretches of the forefoot accompanied by several exercises.
The wearing of plantar orthotics is also recommended to limit the advance of the deformation and the pain felt.
The use of wide and suitable footwear helps to release the toes and reduce nerve compression.
Corticosteroid infiltration between the toes is also one of the methods used. Infiltrations work well but their effectiveness over time is limited.

Surgery

In 50% of cases, non-surgical treatment is not enough and neurosis surgery becomes mandatory. There are several techniques for Morton syndrome surgery.

The surgical technique used depends on the degree of damage to the nerve and its thickening:

In case of significant thickening of the nerve, open-pit surgery is recommended.
In case of moderate thickening, Dr.Julien Lopez performs the surgery of the percutaneous neuroma.

The use of minimally invasive surgery and percutaneous gestures:

Neurolysis consists of the release of the compressed nerve thus suppressing the pain. This procedure can be performed in the open or by a percutaneous method by cutting the ligament responsible for compression with a 2 mm incision.
It is also possible to combine percutaneous surgery and neurolysis by performing bone sections of the 3rd and 4th metatarsals to adjust the inner supports.
Dr. Julien Lopez may also decide to perform the total resection of the nerve. This intervention leads to a permanent loss of sensitivity at the tip of the toes. The neurectomy or neurectomy of Morton syndrome has no effect on the mobility of the toes.

Surgical follow-up of the percutaneous operation of Morton syndrome

Thanks to the combined use of minimally invasive surgery and local anesthesia, post-operative pain due to percutaneous surgery of Morton’s syndrome is greatly reduced. In order to fight effectively against pain, the anesthetist carries out a prescription of painkillers and anti-inflammatories to be taken after surgery.

The patient can benefit from a quick return home only a few hours after the procedure.

Support and walking are possible right out of the clinic with the wearing of therapeutic shoes. The shoe can be worn for 3 weeks after the operation, it is a comfort treatment and its wearing is not mandatory if the patient walks easily barefoot or in conventional shoes. Crutches are required when leaving the clinic due to prolonged foot anesthesia.

A dressing will be made on the day of the operation and will have to be changed every 2 days until complete healing (15 to 21 days). The stitches are dissolvable, they dissolve by themselves and do not need to be removed by the nurse. It is also important not to wet the dressing for 2 weeks. To make your task easier, it is possible to use a waterproof protective cover available to buy in the pharmacy.

During the 1st postoperative week, it is essential to rest the foot, raising and icing the foot regularly.

Driving is allowed one week after the operation depending on the intensity of the pain.

Return to work is possible after a few days after the surgery thanks to the wearing of medical shoes.

It is important to note that a feeling of walking on a ball may persist for 2 months after the operation. This is the postoperative hematoma.

The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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Percutaneous surgery of Morton’s syndrome