At North Jersey Podiatry our treatment is performed on an outpatient basis usually about one hour in length. Under appropriate anesthesia Dr. Klein finds the nerve and releases the areas of compression – the deep transverse intertarsal ligament. Intrinsic fibrosis or scarring is released and the epineurium is opened. THE NERVE IS NOT CUT OUT.
Why do we not cut out the nerve?
When a nerve is cut, the piece of nerve that is beyond the cut point eventually dies, however, its Schwann cells that encircle the nerve fibers remain for a longer time. These cells secrete a chemical messenger known as nerve growth factor that instructs the cut end of nerve to grow back. Unfortunately, multiple nerve sprouts grow in a disorderly array in multiple directions forming a knot of nerve fibers. This leads to the formation of a TRUE NEUROMA. If this forms in an area of pressure, it will become very painful.
Recurrent Neuromas or Prior Nerve Excision
Once a nerve is cut and removed the natural physiologic process is for the nerve to grow. If growth occurs and is painful then excision of this nerve portion is required with placement of the new stump implanted into a muscle via a RPNI (Regenerative Peripheral Nerve Interface) or bone using microsurgical techniques. When the bottom of the foot is affected the nerve end is buried deep into a muscle in the non-weight bearing portion of the arch where it will not be subject to weight or compression.
Risk Involved with Morton’s Neuroma Surgery
The biggest risk associated with this operation is that the patient may still be left with areas of pain or there is no change in the amount of pain. Common risks associated with any type of surgical procedure include bleeding, infection and scaring. Other risks include an increase in pain (which is usually the progression of the neuropathy not an operative complication) or Deep Vein Thrombosis which are uncommon.