Morton’s Neuroma Surgery and Recovery

There aren’t that many detailed accounts out there about the surgery and recovery long term, so I’m recording my journey in case it might help someone else! I’m also speaking about everything else I tried and why I ultimately opted for the surgery. Hopefully this will provide some information and encouragement to other runners and active people who are considering having this procedure done. It’s a bit long but I want to share everything I can.

With my lovely crutches and surgical sandal post Morton’s Neuroma operation!

I’ve had the misfortune to be plagued with a Morton’s Neuroma since the end of 2018, which is not great news for a runner! I suspect that it was down to wearing a pair of running shoes that were far too narrow for me. [A note from me: Try to get your shoes professionally fitted in a running shop if you can and make sure your toes have room to spread!] 

I tried everything to get rid of it, including a cortisone shot. Many people do find relief from them, but unfortunately I was one of the unlucky ones who didn’t – I think in my case, it actually made things worse. Not to mention that it was quite the traumatic experience, as I got so stressed out by the needle I actually passed out and had to spend a while recovering in a reclining chair while being fed sugar tablets by the podiatrist. Oops!

I had this cortisone shot done via the NHS, who advised me that if it didn’t work, surgery was the only option left for me. However, it was made to sound quite scary – I was told that in order to remove the neuroma, they would likely damage some of the ligaments or tendons in the process, which would destabilise my entire forefoot. Basically, they told me to give up all hope of running ever again.

Obviously that wasn’t an option for me, and I was determined to do everything possible to avoid surgery. I was able to manage my symptoms for a while through home remedies. Key ones were moving to wide fit trainers and comfortable every day footwear, like Birkenstocks [note – don’t forgot that your socks should allow your toes room to spread as well!]. I didn’t get any advice about this through the NHS – this was down to my own research and loads of trial and error to find the combination which worked for me.

All of these solutions worked great for about a year, during which I was able to train for and complete a marathon without issue. However, come 2020, my neuroma was plaguing me worse than ever before (and with such bad timing – could have really used running to keep me sane during the pandemic!). I was in such excruciating pain that some days, walking was a struggle, and I had to completely forget about running. I saw one podiatrist, who shoved some orthotics in my shoes that didn’t help at all – if anything, they put me into even worse pain and created new issues.  

After a while of struggling through that, I saw another podiatrist called Jack Lidyard (if you’re in London, I highly recommend him, he’s brilliant!). He let me know that my symptoms were being aggravated by very tight calf muscles, which we sorted out through a combination of acupuncture, foam rolling and deep stretching. I could resume running but never the longer distances that I loved, and the neuroma remained a constant nagging presence that would flare up when I did too much. Racing was completely out of the question, and while I had other activities I enjoyed, like weight lifting or cycling, I was never as happy as I was when I could run reliably.

After spending a week coaching at a training camp in March 2022 where my foot was in bits by the end, I finally decided enough was enough. I couldn’t train or coach in the way I wanted, and it’s hard to plan races or active holidays when you’re not sure if your foot will cooperate or not.

THE SURGERY

I  waited until the end of summer 2022 to have this done, when I knew I had a big block of time without traveling or events coming up. I was very fortunate to have insurance cover through my fiancé’s new job, but I had previously been willing to pay out of pocket for private care. I think the NHS is an incredible thing to have and we are lucky in the UK that anyone can get the healthcare they need, but with a surgery this crucial to my job and overall health, I wanted to ensure I was getting the best surgeon possible. Plus, it also meant I could have the surgery fairly soon, rather than sitting on a potentially endless waiting list.

After seeing which surgeons my insurance would cover, I opted for Sam Singh at London Bridge Hospital. He has brilliant reviews and is one of the top surgeons for this procedure. He was very reassuring about my chances of getting back to endurance running, and said that what the NHS had told me about forefoot destabilization was nonsense.

He also explained that some surgeons only remove the neuroma itself, which may result in something called a ‘stump neuroma’ – essentially, the neuroma eventually regrows as there is still pressure in the offending area. His method is to remove the long tail of the nerve up to the arch of the foot, so that if a stump neuroma ever did grow, it would be impossible to feel because you do not put pressure into your arch as you do with the ball of your foot. The recovery is slightly lengthened with this method, but the long-term prognosis is far better. 

The surgery itself is a day case, so I arrived at noon and was able to go home around 8 pm. I checked in, had visits from the physiotherapist and anesthetist, a bit of a wait, then was walked down to the operating theatre. All in all, I believe the surgery only took around 30 minutes or so. Afterwards, I spent a while in recovery, was wheeled back to my room, had something to eat, was given some crutches and a surgical sandal, and then my fiancé took me home (you will need someone to stay with you for the first 48 hours at least). All in all, pretty straightforward. I would say the waiting was actually worse than the operation itself, and all my nerves turned out to be for nothing. In the end, it was all very smooth and simple!

Once I got home, my job was to elevate the foot and recover! At this point, it felt like a big block of concrete, still numb from the operation. They sent me home with some opioid painkillers, but told me to try to manage the pain with ibuprofen and paracetamol first. Everybody is very different, but I never really had pain after the operation, just strange burning and tingling sensations from the nerve healing – never anything that made me want to take the strong stuff. I took ibuprofen for about a week and then stopped altogether. [I really want to emphasize that this was my personal experience, and some people may feel more significant pain after the operation].

After the surgery, it’s so important to elevate the foot as much as you can. I was very lucky that Alex, my fiancé, was able to take on all of the cooking, washing up, and house chores, which meant I could stay off my feet for two weeks and really not worry about pushing myself too hard. I definitely think it’s important to take as much time off work as you can (or work from home) to ensure you’re giving yourself the best shot at recovery.

Two weeks post operation, I had a follow up appointment with the surgeon to remove the bandages and check on the stitches. I was lucky that mine were the dissolving sort, so no need to mess around with removing them. The surgeon wanted me to go straight into normal shoes, but I hadn’t weight borne at all for two weeks, so I did experience shooting pains where the neuroma used to be when trying to walk normally. He said that many people can leave this appointment in their own shoes, but I suppose I’m just a slow healer! I left in the surgical sandal and still with the crutches to proceed at my own pace. If you know it’s not right, it’s better not to push it, even if the surgeon tries to convince you it’s fine.

He recommended I see a sports-focused physiotherapist in order to help progress my recovery, and looking back now, it is 100% the best thing that I did – I don’t know how I would have managed without her! (Shoutout to Natasha Fernandes at MyChiro Clinic in Canary Wharf. She is incredible and has been hugely instrumental for my recovery).

Post-surgery, I developed a bit of a limp due to the fact that my foot was still swollen and the metatarsal heads had dropped, making it difficult to walk. The nerve in the operated leg had also tightened up, which was something we needed to ease out over time. She actually had me use one crutch (on the opposite side to the operated foot) in order to encourage a natural gait cycle, which was really helpful. I also had a pair of really comfy Sketchers that I bought to use inside, and used a pair of old running shoes if I went out. Having wide fitting soft shoes at this stage of the recovery is super important, and made a big difference in the way I was able to walk.

I used the crutch until about 5 weeks post operation, which I found marked the biggest turning point in my recovery. I felt able to walk more normally, and started to return to some of my coaching work, albeit sat in a chair alongside the track! In terms of exercise, I started with some gentle cycling (with the pedal towards my heel) and some upper body gym work. Some people start working out sooner, but I did what felt right for me in the moment, and what my physio said was okay to do.

A  couple weeks later, I was able to return to short distance commute cycling, using the rowing machine at the gym, and had the okay to start building lower body strength at the gym again. Before I was allowed to think about running, Natasha wanted to make sure that I had enough leg strength for my body to cope with the demands of impact.

Initially, she estimated around 3 months after surgery as the first time I could think about running again, and I was perfectly happy to be patient and work through the various exercises I had been assigned [I won’t be sharing these as they were extremely specific to my biomechanics]. But when I went for my appointment about two months after surgery, she surprised me by saying that I could try out running! It was only a short series of run / walk intervals on soft surfaces like grass or a running track, but I was so thrilled to be back, even despite the supreme lack of fitness. Also, it was amazing just how weak the right side of my body was compared to my left.

In the grand scheme of things, eight weeks to return to a little bit of running is fairly short. Surgeons often quote running as being possible at four weeks post-surgery, but through my own experience and speaking to my physio, this probably possible in only a tiny minority of cases. Four weeks is about the amount of time it takes for the incision to heal, but it doesn’t account for a restoration of mobility, whether swelling will still be present, if there are any nerve sensations, etc. Six weeks is the quickest account I’ve ever heard an example of, but I think most people will be around eight to twelve weeks, if not longer. Everyone is extremely individual, so you need to take all of these accounts with a grain of salt, and above all, be patient and enlist a knowledgeable physio if you can. I think it’s helpful to anticipate the healing process taking longer, so that you won’t feel disappointed if yours doesn’t meet the timeframe your surgeon gives you.

Around 11 weeks post operation, I was okayed to return to gym and cycling activities as normal, while still keeping to the run/walk intervals. I completely obeyed all of my physiotherapy guidelines and had a visit every week, which I believe has allowed me to make such a quick recovery. Without Natasha’s help, I do feel like I would have struggled through the recovery process and wondered why it was taking me so long to get better. Again, this may be individual and some people will be fine on their own, but having professional guidance week in and week out was invaluable to me.  

Around four to five months in, my foot is almost entirely back to normal. There isn’t really any swelling anymore, and the scar has healed nicely (and is actually almost invisible!). After taking the bandages off at week two, the pain in the ball of the foot was quite sharp, but it lessened every day with use as the body learned that there was actually no reason for it to worry! The most important thing at this stage is not to be discouraged if you do have some pain in the ball of the foot – every single day I found to be an improvement. Sometimes the arch of my foot will still tingle if I touch it, but this also lessens over time as the nerve desensitises.

I can walk normally now, and return to a normal level of activity, with a very slow build-up of running (I was only able to return to running on pavement around nine weeks in). However, if I push myself too hard and do too much, my foot is liable to swell and become a bit “grumpy.”

UPDATE FROM JUNE 2023, APPROX. 10 MONTHS POST OP

In May 2023, I was able to complete the Keswick Mountain Festival 25K trail race – a fairly stony and challenging course in the Lake District – without any issues. My foot felt completely normal and even the day after the race, it felt fine!

In regards to the training for this race, I did have to listen to my body a lot more and hold back from pushing my foot too hard. Each new stimulus, such as elevation and uneven terrain, had to be incorporated gradually over time, starting from almost nothing, and I had to be willing to take a step back and rest if I accidently made my foot sore. The reason this was happening was due to the stiff scar tissue left in the space where the neuroma was. This takes time to loosen up and begin to move naturally with your body. 

Ultimately, I have been able to return to running normally and will be training for the London Marathon in 2024.

For those curious about how my foot feels now, I would say it largely feels normal. I do occasionally get a tingling / very slight burning sensation in the toes either side of where the neuroma was located, but this doesn’t really bother or affect me at all. The nerve in the arch of my foot will still tingle a little if I touch it, but this sensation has drastically reduced over time. Cutting and filing my nails on the affected toes still feels a little strange, but it’s not a big deal! 

Ultimately, I am glad that I opted for the surgery, as I have been very fortunate with the high quality medical team around me, as well as a relatively smooth recovery process. If you are thinking about this surgery, please remember that this is my personal experience and everyone reacts to the operation differently. I remember when I was debating having this procedure done, I could only really find negative accounts online which frightened me. By sharing my experience, I wanted to let you know that there are positive cases as well – they just aren’t being shared!

If you are considering this surgery, I think it is important to find the right surgeon and physiotherapist to help you in your recovery, as well as to have realistic expectations of what you can do post-op. Please expect that recovery will take much longer than what your surgeon might quote you, or you may read online. I believe also that the amount of time you are able to stay off your feet in the initial stages of recovery makes a big difference, so if you can, recruit friends and family to help you with your chores. Invest in some comfortable shoes (Birkenstocks and wide-fit Sketchers were fantastic for everyday wear, as were wide-fit running trainers).

I hope this account might be helpful to you in some way. I’m always happy to discuss further if you have any questions.