Neuroma Surgery: Neurectomy, Decompression, Recovery, and What to Expect

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✅ Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

Neuroma Surgery: Neurectomy, Decompression, Recovery, and What to Expect

What Is Neuroma Surgery?

Neuroma surgery — most commonly performed for Morton neuroma — removes or decompresses an enlarged, irritated nerve between the metatarsal bones of the forefoot. Morton neuroma typically affects the nerve between the third and fourth toes, causing burning, shooting pain, and the sensation of standing on a pebble. Surgery is considered after conservative treatment fails to provide adequate relief.

When Is Surgery Recommended?

Most neuromas are successfully managed without surgery. Wider shoes, metatarsal pads, custom orthotics, and corticosteroid injections resolve symptoms in the majority of patients. Surgery becomes the next step when pain persists despite 3 to 6 months of conservative care, when diagnostic injections confirm the neuroma as the pain source, and when imaging (ultrasound or MRI) documents nerve enlargement consistent with symptoms.

Neurectomy: The Standard Procedure

The most common surgical approach is neurectomy — complete removal of the affected nerve segment. The surgeon accesses the nerve either from the top of the foot (dorsal approach) or the bottom (plantar approach). The dorsal approach allows earlier weight-bearing because the incision is not on the weight-bearing surface, but visualization is slightly more limited. The plantar approach offers better direct visualization but requires more careful wound protection during healing.

The nerve is identified, traced proximally, and excised. A portion of the proximal nerve stump is buried in muscle to reduce the risk of stump neuroma formation. The excised tissue is sent for pathological analysis to confirm diagnosis.

Nerve Decompression as an Alternative

Some surgeons prefer nerve decompression — releasing the transverse metatarsal ligament that lies above the nerve — rather than excision. This approach preserves the nerve and avoids permanent numbness in the affected toe cleft. Results from decompression are generally good, with some series reporting outcomes comparable to neurectomy, and it leaves the option for neurectomy available if needed later.

Recovery After Neuroma Surgery

Neuroma surgery is performed as outpatient surgery under local anesthesia with sedation. With the dorsal approach, many patients walk immediately in a post-operative shoe. Pain and swelling are common in the first 2 weeks. Return to regular shoes is typically possible at 4 to 6 weeks. Full recovery, including complete resolution of surgical swelling and any residual sensitivity, takes 3 to 6 months.

Permanent numbness between the affected toes is expected after neurectomy — the nerve has been removed. Most patients find this preferable to the pre-surgical burning pain, but it is important to understand before surgery that some sensation change is permanent and intended.

Risks and Complications

The most significant complication is stump neuroma — a painful regrowth of nerve tissue at the cut end. This can cause symptoms similar to or worse than the original neuroma and may require additional surgery. Infection, scar tenderness, incomplete relief, and transfer of symptoms to adjacent nerve spaces are other possible outcomes. Success rates for neurectomy in carefully selected patients range from 75 to 85 percent in published series.

Alcohol Sclerosing Injections as a Non-Surgical Alternative

A series of ultrasound-guided alcohol sclerosing injections can shrink and deaden the neuroma without surgery. Multiple injections spaced 7 to 10 days apart are required, and results vary, but some patients achieve sustained relief that avoids surgery entirely. This option is worth discussing with your podiatrist before committing to excision.

Questions to Ask Before Surgery

Before scheduling neuroma surgery, confirm the diagnosis with a diagnostic injection, ask about the approach (dorsal vs. plantar) and the reasoning, understand what permanent changes to expect in sensation, inquire about the surgeon is volume of neuroma procedures, and ask about outcomes data and revision surgery rates at their practice.

Stump Neuroma: When Neuroma Recurs After Surgery

The most significant complication specific to Morton’s neurectomy is stump neuroma — a new, painful neuroma forming at the proximal end of the resected nerve. When the nerve is cut, the proximal stump naturally attempts axonal regeneration, and if this regenerating nerve end encounters scar tissue, mechanical pressure, or inflammatory stimulation, it can develop into a new neuroma at the resection site. Stump neuromas are typically more challenging to treat than the original Morton’s neuroma because the scarring from the initial surgery complicates subsequent dissection.

Prevention is the most effective strategy: ensuring adequate proximal resection length during the initial neurectomy (leaving the stump in fat tissue well away from weight-bearing pressure, not in the immediate forefoot region) significantly reduces stump neuroma incidence. When stump neuroma does develop, treatment options include ultrasound-guided alcohol sclerosing injections, surgical re-excision with more proximal nerve resection, and nerve end burial into bone or muscle to prevent regeneration into a compressed scar. Accurate diagnosis of stump neuroma requires distinguishing it from scar tissue pain and residual or recurrent interdigital neuroma — diagnostic ultrasound by an experienced sonographer is the key imaging tool. At Balance Foot & Ankle in Howell and Bloomfield Township, we evaluate and manage both primary Morton’s neuroma and stump neuroma complications from prior procedures.

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Related Treatment Guides

• Custom 3D Orthotics
• Morton’s Neuroma Treatment
• Plantar Fasciitis & Heel Pain Treatment
• Sports Foot & Ankle Injury Treatment

Michigan patients experiencing foot or ankle problems can schedule an appointment at Balance Foot & Ankle — with locations in Howell (4330 E Grand River) and Bloomfield Township (43494 Woodward Ave #208). Call (810) 206-1402 for same-week availability.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your Morton’s neuroma, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Township offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Morton’s Neuroma and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Capsulitis (2nd MTP). Pain at 2nd-toe base rather than between toes; drawer test positive.
• Stress fracture. Single-point tenderness over a metatarsal shaft, not between toes.
• Freiberg’s infraction. AVN of metatarsal head, classic radiograph flattening.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Adding a cushioned insole instead of a metatarsal pad. Fix: place the metatarsal pad PROXIMAL to (behind) the metatarsal heads — not directly under them.

Warning Signs That Need Same-Day Care

More questions patients ask

What causes heel pain?

Heel pain most commonly results from plantar fasciitis (inflammation of the plantar fascia ligament), which accounts for approximately 80% of cases. Other causes include Achilles tendinitis, heel spurs, stress fractures, Baxter's nerve entrapment, and fat pad atrophy. Dr. Biernacki performs a thorough biomechanical evaluation to identify the precise cause. Call 810-206-1402 for a same-day appointment.

How long does plantar fasciitis take to heal?

With proper treatment, most plantar fasciitis cases improve within 6-12 weeks. Conservative treatments include custom orthotics, stretching protocols, physical therapy, and corticosteroid injections. For persistent cases beyond 6 months, Dr. Biernacki offers advanced options including shockwave therapy and minimally invasive procedures with 90%+ success rates.

Should I see a podiatrist for heel pain?

Yes. A board-certified podiatrist like Dr. Biernacki can accurately diagnose the cause of heel pain using X-rays and diagnostic ultrasound, ruling out stress fractures and other serious conditions. Self-treatment with over-the-counter insoles often delays proper treatment and can worsen the condition. Early intervention leads to faster recovery.

Still have a question about coverage or cost? Book online and we will check your benefits before your visit: Book in Howell · Book in Bloomfield Township. Prefer to talk it through first? Call (810) 206-1402.