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MORTAN'S NEUROMA

MORTAN'S NEUROMA

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A Mortan’s ‘Neuroma’ is thickening in and around the nerve in the second or third webspace. The nerve can become so large that it moves upwards when the foot pushes off during gait. Most Mortan’s improve with steroid injections. If I recommend that you have excision of the painful nerve, you will have already tried injections, you will have had an MRI and US showing a thickening of the nerve, and you will have had several examinations by myself which always find the Mortan’s in the same webspace in your foot and I will have excluded all other causes of forefoot pain.

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What can I expect on the day of surgery?

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  • The surgery will normally be under a general anaesthetic.

  • This is a day surgery case.

  • I will numb the foot and ankle with local anaesthetic so that you will be comfortable when you wake.

  • There will be a big bandage on your foot and ankle which you will keep dry and intact for 2 days

  • You will be given crutches and a post op shoe to wear

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What are the risks and complications?

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Most patients do extremely well. A small group of patients need extra physio due to ongoing pain. Rare complications include infection, DVT, numbness in the webspace, CRPS, stiffness, swelling, and failure to improve symptoms

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Clear Advice About DVT

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A DVT is a Deep Vein Thrombosis or a blood clot in the leg. A blood clot occurs after forefoot surgery for about 1 in every 400 patients. You can help prevent a blood clot by keeping your knee and ankle and toes moving. Keeping yourself hydrated is also helpful to prevent a DVT. Finally elevating your leg to the level of your heart will minimise the amount of swelling you have which will also help to prevent a DVT.

 

If you were the unlucky patient who developed a DVT you would likely have some symptoms:

  • The leg (above the dressing/foot) would become hard, heavy, swollen, painful and/or red

  • If you were to have any of the above symptoms you would have to have a scan to look for a blood clot and then be treated with blood thinners

If the blood clot were to move to the lungs you would have a pulmonary embolism which is a medical emergency

  • The symptoms of a pulmonary embolism are breathless & chest pain- Call 911

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When can I drive?

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The best guide that you are safe to return to driving is that you are able to walk well without crutches and without the surgical shoe. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic.

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  • Right side surgery and all car types: 2 weeks

  • Left side surgery and manual car:     2 weeks

  • Left side surgery & automatic car:     1 weeks

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How long will I need to off work?

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The time you require off from work depends on what type of job you do. The first week or two of healing is critical and so should have this time off work. Many people are able to work from home and so if you avoid commuting in the first tow weeks, you will find that your foot does better. If you work on your feet all day, do a manual job, or are required to wear dress shoes you may need 2-3 weeks before you are back at work.

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What instructions will I have for the first 2 weeks after surgery?

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  • Elevate leg level to heart (above if swollen)

  • Keep foot dry for 2 weeks

  • Remove Bulky outer dressing after 48 hours

  • Keep adhesive dressing intact

  • Move Toes and Ankle

  • Touch Weightbear with crutches for the first two days and then progress as you are able

  • Wrap a pack of frozen peas in a tea towel and ice foot for 15 minutes at a time (pea pack ideally bought for this purpose and never to be used for any other)

  • Please remember that standing and walking in the first 2 weeks puts pressure on the healing wound. The more you stay off your foot, the better your wound will heal.

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SELF EXERCISES

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Start immediately (Day 1) post op and repeat as often as you can.

(Please don’t remove your dressing these photos are just to illustrate clearly what you should do)

  1. In your dressing wiggle your toes up and down as much as you are able to do

  2. Try to pick up a tissue with your toes

  3. Grip all of the toes and move the toes as far down as it will go and then as far up as they will go

      Passive Dorsiflexion                                                                                    Passive Plantarflexion

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What happens at 2 weeks in clinic?

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  • You will attend my foot & ankle clinic to check your wound

  • You will then be able to wet the wound and wash the toes.

  • The surgical scar will feel hard for up to 3 months

  • Please do not give up on wound massage during the first 3 months following surgery

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Physiotherapy and instructions for the period from 2 weeks to 6 weeks following surgery

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  • Gradually increase the amount of time you spend standing and walking

  • Continue to elevate your foot when it is swollen

  • Continue to do the exercises to move the toe up and down regularly

  • You may do pilates exercises/ abdominals and core (but only those where you are laying on a floor mat and no standing exercises)

  • Also stretch gastrocs, & hamstrings with theraband or towel wrapped around foot

  • Contrast bathing in hot water 30 sec and cold water for 20 sec. Repeat for 5 minutes

  • Wound massage with Bio Oil

  • Expect the webspace to be numb but by firmly massaging the foot you can help to desensitize it

  • Work on walking normally and evenly

  • Continue to do active and passive movements of the toes

  • Sit in a chair THEN:

  • Practice pushing your whole of the toes down into the floor

  • Once you are doing this well, lift your heel and start to push up onto tip toes repeat 20-30 times minimum

  • Pick up tissue paper from floor with toes Repeat 10-20 times

Clinic Appointment 6 weeks following surgery

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  • This is to check your gait and to confirm the results of the specimen sent for histology at surgery

Physiotherapy and instructions 6 weeks+ following surgery

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‘SURREY STAGES’

The Surrey Stages is a Foot & Ankle Rehabilitation Program designed to continue to strengthen the healing tissues while preventing injury as healing takes place

 

BRONZE AWARD

  • DOUBLE HEEL RISES (DHR)

  • You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each

  • You are working towards a normal gait (perhaps slightly slower to start)

  • All pilates exercises & gym equipment with foot plate (bike, rowing machine, X-trainer)

  • Note: If you and your physio are struggling to help you progress past the bronze award, start to wear a backpack and slowly increase the weight/ number of books in the back pack. Eventually you will be able to discard the back pack and progress to the Silver Award

 

SILVER AWARD

  • DOUBLE HEEL RISES WITH A LIFT

  • You go up on both feet but lift unoperated leg and lower slowly only on operated leg

  • 3 sets, working to 15 reps in each

  • You can stand both feet on a wobble board

  • You can hold a solid DHR for 20 seconds

  • You can skip on the spot (low height) with both legs

 

GOLD AWARD

  • SINGLE HEEL RISES

  • 3 sets, working to 15 reps in each

  • You can stand on one foot on wobble board

  • You can hold a solid DHR for 40+ seconds

  • Very gentle jogging

 

PLATINUM AWARD

  • Progress to hopping in all directions

  • Double and Triple Hops

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