Compressed nerves can become enlarged and painful, but neurolysis or nerve surgery can help treat the condition and alleviate discomfort. When nerve tissue becomes inflamed, it is known as a neuroma. This commonly occurs on the ball of the foot between the third and fourth toes or the second and third toes, often as a result of injury or trauma. To treat a neuroma, your doctor may perform neurolysis or nerve surgery. Neurolysis works by hardening the nerve, while surgery involves either removing the affected nerve tissue or reducing the pressure on the nerve.

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Reasons for Nerve Surgery

Nerve surgery is typically performed to relieve the pain and discomfort caused by a neuroma. These procedures are usually considered when other treatments have failed to provide adequate relief.

How Neurolysis is Performed

Neurolysis involves injecting a mixture of ethanol and anesthetic into the nerve to harden it. This procedure may need to be repeated once a week for several weeks to effectively destroy the nerve and alleviate symptoms.

Nerve Surgery Approaches

Nerve surgery can be performed using two main techniques: the plantar approach or the dorsal approach.

  • Plantar Approach
    In the plantar approach, the surgeon removes the nerve tissue through incisions made on the sole of the foot. This allows direct access to the neuroma. After surgery, crutches are typically needed for at least three weeks to avoid placing weight on the surgical site. While this method provides a direct route to the neuroma, a scar may form on the bottom of the foot, which can cause discomfort when walking.
  • Dorsal Approach
    The dorsal approach involves releasing the metatarsal ligament through an incision on the top of the foot to reduce pressure on the nerve. Recovery is generally quicker with this method since the incision is on the top of the foot. However, releasing the ligament can lead to future instability in the forefoot, which may require additional treatment down the line.

In both approaches, the goal is to relieve pressure on the nerve and reduce symptoms, though recovery times and risks vary depending on the method used.