Medical treatment of Morton syndrome
The treatment of Morton’s neuroma is primarily medical. Its indication is based on the importance of discomfort.
- First prescription of orthopaedic soles for discharge of the corresponding support area. They support concerned metatarsal heads upstream, thus opening up space, and decompressing the nerve. These soles should be thin, not taking up too much space in the shoe. We also adapt the shoes with the wearing of flat shoes, without high heels. We recommend a rest with initial stop, running to the athlete.
- Modern techniques, such as percutaneous laser, have never been scientifically effective. The laser will heat the tissue without anesthesia, to decrease inflammation. Phenolisation (chemical destruction of the nerve) has also not proved its interest.
- The infiltration of an anti-inflammatory type corticoid with a lasting effect. It is realized in the painful inter-metatarsal space in consultation. It brings an inconstant relief but that can be lasting. It therefore deserves to be tried, especially in the case of small Morton syndrome, with a strong inflammatory component. Morton’s neuroma, large or old, are not responding well to infiltrations.
Surgical treatment of Morton syndrome
In case of failure of medical treatments, a surgical procedure is proposed, in ambulatory. This procedure involves the removal of Morton’s neuroma. It involves the bifurcation of the plantar nerve’s removal. This causes a complete anaesthesia (loss of sensitivity) of the corresponding space causing no discomfort.
This procedure is preferable to the simple release of the nerve too often source of failures. It is a painless procedure because it involves only the soft tissues, and without bone action. After loco-regional anaesthesia, the incision is centered on the commissure between the affected toes. The scar will be 15 to 20 mm in the long term, almost invisible.
In case of abnormalities of the metatarsal heads, it is possible to associate bone slices (osteotomies). The suites then last longer. Simple intermetatarsal ligament techniques, called neurolysis (nerve’s release), have inconsistent and time-consuming results.
Post-operative Suites after Morton Syndrome Surgery
These suites are usually simple. The hospitalization takes place in ambulatory. Support is allowed immediately under cover of a heel shoe. The work stoppage is from 15 days to 1 month. The resumption of a sporting activity can be considered after one month.
The surgeon will confirm during the post-operative visit that the microscope examination confirmed the diagnosis of neuroma. Recidivism is not possible if confirmed. Nevertheless we can observe in the aftermath of a Morton syndrome, a recurrence in another inter-metatarsal space or on the opposite foot.
Swelling (edema), scarring disorders (smoking prevention, heel shoe), and persistent pain (old Morton’s neuroma) can occur. As with any intervention concerning the forefoot, smoking should be stopped. This is an excellent opportunity to start a withdrawal.