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Neuroma Surgery

Neuroma Surgery

Neuroma surgery is a procedure performed to treat painful nerve growths, known as neuromas, that develop after injury or chronic irritation of a nerve. A neuroma forms when a cut or damaged nerve tries to heal but ends up producing an irregular bundle of nerve fibers and scar tissue instead of reconnecting smoothly. This abnormal growth can become very sensitive, leading to sharp, burning pain, tingling, or electric shock-like sensations when touched or compressed.

Neuromas are most common in the hand, foot, or areas where nerves are prone to injury, such as after trauma, surgery, or repetitive strain. One of the best-known examples is Morton’s neuroma, which occurs between the toes in the foot. However, neuromas can occur anywhere in the body where a peripheral nerve is damaged.

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Causes of Neuroma Formation

Neuromas develop when the protective sheath of a nerve is injured and regenerating fibers cannot reconnect properly. Instead, they grow in a disorganized way, creating a painful swelling. Triggers include:

  • Accidental nerve injury during trauma or surgery.
  • Repetitive compression or irritation of a nerve (e.g., from footwear in Morton’s neuroma).
  • Scar tissue trapping or tethering a nerve.
  • Amputations, where “stump neuromas” may form.

Symptoms

  • Sharp, burning, or stabbing pain.
  • Tingling or numbness in the distribution of the affected nerve.
  • Pain that worsens with pressure, movement, or specific footwear (in foot neuromas).
  • Localized tenderness when the neuroma is pressed.

Indications for Surgery

Surgery is typically considered when non-surgical methods—such as rest, footwear modifications, orthotics, medications, physiotherapy, steroid injections, or nerve blocks—do not provide lasting relief. Indications include:

  • Persistent or worsening pain despite conservative treatment.
  • Functional impairment, such as difficulty walking, grasping, or using the hand.
  • Large or symptomatic neuromas confirmed by imaging or clinical examination.

Surgical Techniques

The goal of neuroma surgery is to remove or reconstruct the painful nerve segment and reduce the risk of recurrence. Several approaches are used depending on the location and severity of the neuroma:

1. Neuroma Excision

  • The most common technique.
  • The surgeon removes the neuroma by cutting out the damaged nerve segment.
  • To minimize regrowth, the cut nerve end is carefully managed.

2. Nerve Repair or Grafting

  • If the neuroma is on a nerve with critical function, the surgeon may attempt to reconnect the nerve ends after excision.
  • In cases where there is a gap, a nerve graft (using a donor nerve from elsewhere in the body or synthetic conduit) may be placed to bridge the defect.

3. Relocation of the Nerve End

  • To reduce the risk of recurrent neuroma formation, the surgeon may bury the nerve end in a muscle, bone, or fat tissue, where it is protected from friction and pressure.

4. Targeted Muscle Reinnervation (TMR)

  • A modern technique used particularly in amputees.
  • After removing the neuroma, the cut nerve is connected to a nearby motor nerve branch, giving the regenerating fibers a “target.” This reduces pain and may improve prosthetic control in amputees.

5. Regenerative Peripheral Nerve Interface (RPNI)

  • Involves wrapping the cut nerve end with a small piece of muscle graft.
  • Provides a biologic environment that reduces painful neuroma regrowth.

Recovery and Rehabilitation

  • Hospital stay is usually short, often outpatient or overnight.
  • Pain relief is noticeable in many patients within days to weeks, though some discomfort at the surgical site is expected during healing.
  • Physical therapy may be required, especially if the neuroma was in the hand or foot, to restore mobility and strength.
  • Gradual return to activities is encouraged, avoiding pressure or repetitive strain on the operated site during early recovery.

Recovery time varies depending on the site of surgery and whether reconstruction (such as grafting) was performed. Some patients regain full function within weeks, while others may need several months.

Risks and Complications

Neuroma surgery is generally safe, but potential risks include:

  • Recurrence of neuroma or persistent pain.
  • Numbness in the area supplied by the excised nerve.
  • Scar sensitivity or stiffness near the surgical site.
  • Infection, bleeding, or delayed wound healing.
  • Rarely, complex regional pain syndrome (chronic pain condition).

Careful surgical planning and modern techniques such as TMR or RPNI have improved long-term success rates and reduced complications.

Outcomes and Prognosis

The majority of patients experience significant pain relief and improved function after neuroma surgery. Success rates vary depending on the nerve involved, duration of symptoms, and presence of underlying conditions. In cases like Morton’s neuroma, outcomes are generally very good. For complex traumatic neuromas, results can be more variable, but advances in nerve repair and biologic reconstruction have enhanced prognosis.

Importance of Early Treatment

Leaving a painful neuroma untreated can lead to chronic pain, reduced mobility, and secondary issues such as altered gait, joint strain, or impaired hand function. Early recognition of symptoms and timely surgical management prevent worsening disability and improve quality of life.

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