A 32-year-old avid runner presented in my clinic with a longstanding Morton’s neuroma, diagnosis (diagnosed by her GP and Physiotherapist) that had significantly impacted her ability to train and participate in endurance events. Her symptoms had initially been managed with conservative treatment, including changing her footwear, physiotherapy and reducing her running, but these interventions ultimately failed to provide long-term relief. Her frustration with persistent pain led her to seek further consultation.
This lady initially managed her neuroma symptoms with wider-fit footwear, avoiding doing up her laces too tightly on the running shoes, and reducing her training, all of which seemed to give mild reduction in her symptoms, but did not resolve them.
She went on to have some Physiotherapy, which focused on reducing tightness in her calf muscles, working on her balance and proprioception, and looking at her walking and running technique. She also tried some off the shelf insoles which only seemed to exacerbate her symptoms.
In our first consultation we explored all her options to manage her symptoms.
Together we decided to initially try a corticosteroid injection, which is a very safe and common treatment option for Moreton’s neuroma. This initially brought significant pain relief, and the patient was able to get back to her normal life and running training. However, as is often the case, the symptoms returned within a few months, leaving her frustrated and still unable to enjoy running or even walking without discomfort.
After exhausting conservative treatments and given her clinical history, and the fact that her life and mental wellbeing was being so negatively affected, we had an open discussion about surgery.
While the idea of an operation can be daunting, this lady felt ready for a solution that could offer a long-term return to her active lifestyle. We decided that a neurectomy (a procedure to remove the thickened nerve), would give her the best chance at lasting relief.
The patient opted for surgery which was covered through her private health insurance.
The procedure was done as a day case surgery, was performed under general anaesthetic. The Morton’s neuroma was excised along with a significant portion of the nerve, extending to the mid-arch region. This extended excision approach helps prevent the formation of a “stump neuroma,” which could reintroduce symptoms if the nerve were only partially removed. Post-operatively, she was given a surgical sandal and crutches and instructed on pain management, including avoiding opioids if possible.
The surgery went smoothly, and within days the patient noticed a marked difference. The usual pain was gone, replaced by mild, manageable post-operative soreness.
During the early recovery phase, I emphasised the importance of elevating the foot to reduce swelling. The patient’s partner provided extensive support, handling daily tasks to allow for an easier recovery time.
By two weeks, she returned for a follow-up; while healing was progressing well, she still had some residual nerve sensitivity and shooting pain when attempting to walk in clinic, a common response as the nerve heals. At this stage I referred her to Physiotherapy for post operative rehabilitation.
Her recovery was then managed through progressive physiotherapy, focusing initially on reducing nerve sensitivity and restoring functional gait. Physiotherapy interventions included gait training with one crutch, controlled load-bearing activities, and gradual strengthening exercises specific to her biomechanics.
Key to her recovery was a gradual reintroduction to impact-based activities, such as walking and low-impact gym exercises, leading to more advanced exercises like stationary cycling and rowing.
At approximately eight weeks post-operation, she began a carefully monitored return-to-run program. This consisted of brief run-walk intervals on grass to minimise impact. Her progress was monitored weekly, with steady improvements observed in foot strength, gait alignment, and endurance.
A few months post-surgery, the patient was back on her feet in every sense of the word. She returned to running and hiking and was finally free from the nagging nerve pain that had disrupted her daily life.
She completed a 25K trail race 10 months after the surgery which included challenging terrain, with no neuroma-related pain during or after the event.
The patient remains highly satisfied with her surgical outcome, experiencing minimal discomfort and demonstrating an encouraging return to long-distance running. She anticipates training for future marathons and remains mindful of incorporating gradual progression to avoid flare-ups.
This case underscores the potential of surgery as an excellent option for treating Morton’s neuroma when conservative measures are no longer effective.
When managed appropriately, surgery can offer a durable long-term solution; and with careful postoperative management and guidance from a sports-focused physiotherapist, patients can successfully return to high-impact activities.
I would encourage any patient considering surgery to discuss expectations and timelines thoroughly, as recovery varies depending on each individual.
If you’re struggling with this painful condition and conservative treatments aren’t providing relief, it is worth exploring surgical options. Life is too short to be held back by pain, especially for those who thrive on an active lifestyle.
Mr Martin Klinke is one of London’s most trusted, and experienced foot specialists. He performs many bunion surgeries each year, and is a highly skilled surgeon.
He offers this surgical treatment to private self-funded and insured patients at London Bridge Hospital, BUPA Cromwell, and New Victoria Hospital. He also runs outpatient clinics at Chiswick Outpatient & Diagnostic Centre, The Shard, Canary Wharf and One Welbeck.
You can find all his patient reviews here.
