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Forefoot surgery

Neuroma excision

Surgical excision of a Morton's neuroma is highly effective for symptoms that have not responded to footwear changes, orthotics, and injections. The procedure removes the thickened nerve tissue through a small incision in the foot.

Before surgery
The day of surgery
In hospital
Going home
Recovery week by week

Step 1: Your pre-operative assessment

ℹ️ This appointment usually takes place 2-4 weeks before surgery. The assessment is straightforward for most patients.

You will have routine pre-operative checks and meet the anaesthetic team. The team confirms the side and toe interspace involved before surgery.

What will happen at the pre-assessment?

Blood tests and an ECG

Standard pre-operative checks.

Medication review

Blood thinners may need to be paused before surgery.

Anaesthetic discussion

Usually performed under regional ankle block with sedation. The block gives several hours of post-operative pain relief.

Surgical approach

The neuroma can be removed through an incision on the top or bottom of the foot. Top approach allows immediate weight-bearing; bottom approach requires brief non-weight-bearing.

Prepare your home

Keep the foot elevated for the first few days to reduce swelling. Arrange transport home as you will not be able to drive.

The day of surgery

ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.

Arrive at the time given

You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.

Consent and marking

Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.

Anaesthetic

You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.

Recovery room

After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.

In hospital

Most foot and ankle surgery is performed as a day case, meaning you go home the same day. More complex procedures such as ankle replacement or flat foot reconstruction usually require 1-3 nights in hospital. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.

Pain control

You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.

Wound check and dressing

A nurse will check the wound before you leave and explain how to keep it clean and dry.

Crutches and weight-bearing instructions

You will be shown how to use crutches and given clear instructions about weight-bearing on your operated foot.

Discharge letter and follow-up

You will receive a letter for your GP and details of your next outpatient appointment, usually at 2 weeks for a wound check.

You must not drive yourself home

Arrange for a family member or friend to collect you. You must not drive after a general anaesthetic or sedation.

Going home

⚠️ Important: Some numbness between the toes after surgery is permanent. This is the trade-off for pain relief and is well-tolerated by most patients. Less commonly, a stump neuroma can form at the cut nerve end, causing recurrent symptoms.

Elevate your foot

Keep the foot elevated above the level of your heart for as much of the day as possible during the first 2 weeks. This significantly reduces swelling and helps healing.

Keep the wound clean and dry

Avoid getting the wound wet until it is fully healed, usually 10-14 days. Use a waterproof cover when showering.

Take your pain relief as prescribed

Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective than taking it only when needed.

Attend your wound check appointment

This is usually 2 weeks after surgery. Sutures or clips will be removed if used.

When to contact the hospital

Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, calf pain or swelling (possible DVT), shortness of breath, or a temperature above 38°C.

Recovery week by week

Weeks 0-1

Surgical shoe, elevation

Foot wrapped in a bandage and protected in a surgical shoe. Walking with heel-weight-bearing as comfortable.

Week 2

Wound check, stitch removal

Stitches removed. Transition to comfortable shoes if wound healing is satisfactory.

Weeks 2-4

Return to normal walking

Most patients return to comfortable walking. Some residual numbness between the affected toes is normal and permanent.

4-8 weeks

Return to most activities

Return to work, exercise, and most activities.

2-3 months

Return to running and sport

Return to high-impact activity, usually with relief of the original pain.

Common questions

Will I lose feeling in my toes?

Yes. Between the two affected toes. This is permanent but rarely noticeable in daily life.

Can I weight-bear straight away?

Yes, with the top-of-foot approach. The bottom-of-foot approach requires non-weight-bearing for 2 weeks to allow the incision to heal.

How long off work?

Desk work: 3-7 days. Standing work: 2-3 weeks. Manual work: 4-6 weeks.

What if the pain comes back?

Recurrence (stump neuroma) occurs in around 5-10% of patients. Further treatment options are available if needed.

Common questions

Your questions, answered

Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.

Your operationWhat is removed in the operation?

The thickened segment of nerve between the toes is removed (excision).

It is usually a day-case procedure.

Sources  BOFAS
Your choiceWhen is surgery offered?

For persistent symptoms despite roomy footwear, insoles and injections.

Many people manage without surgery.

Sources  BOFAS
WellbeingWill I be numb afterwards?

Yes. Removing the nerve leaves permanent numbness in the affected toes, which most people tolerate well in exchange for losing the pain.

Knowing this in advance helps you decide.

Sources  AAOS OrthoInfo · BOFAS
AnaesthesiaWhat anaesthetic is used?

Usually a general or regional anaesthetic with a foot block, as a day case.

Your anaesthetist will discuss the options.

Sources  NHS
Getting backWhat is recovery like?

Expect a supportive or special shoe for a couple of weeks and a return to normal footwear over a few weeks.

Swelling settles gradually.

Sources  AAOS OrthoInfo
UrgentWhat needs urgent review?

Wound redness, discharge or a temperature can signal infection, and calf or chest symptoms can signal a clot.

Seek prompt help if these occur.

Sources  NHS
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