Stump Neuroma

A Comprehensive Guide to Post-operative Nerve Pain after Neurectomy

Understanding Stump Neuroma: A Personal Journey

Nine years ago, I underwent surgery that changed my life. What is a stump neuroma? Let's explore its risks, impacts, and possible solutions together.

Janet Pearl provides a clear explanation:

"A stump neuroma from Morton’s neuroma surgery occurs in the foot, resulting from the removal of the Morton’s neuroma. It is a nerve disorder that leads to extreme irritation and swelling in the foot nerves, causing excruciating pain. During surgery, the nerve is cut, which can lead to a small growth at the end of the nerve—a ball of nervous tissue known as a Morton’s stump neuroma. This condition is also referred to as a 'recurrent neuroma' or a 'failed Morton’s neuroma surgery.' Morton’s stump neuroma can be a significant source of pain for patients. Even mild pressure on the area, like brushing clothes against it, can trigger discomfort." (Pearl, Janet, MD, USA)

Mr. Ron McCulloch, a podiatric surgeon, adds:

"A stump neuroma is one of the more serious and well-recognised complications of neuroma surgery. It occurs because nerves may try to attach themselves to something when they are cut. This results in a bud of nerve tissue forming at the end of the cut nerve, which can become hypersensitive." (Mr Ron McCulloch, Podiatric Surgeon, FRCPodS, UK)

So, What Happened to My Foot?

During the preoperative assessment, all patients should be informed about the risk of developing a stump neuroma. According to the Royal College of Podiatry database—PASCOM-10—pain around the surgical site can occur in about 4-5% of cases. Interestingly, the recording of stump neuromas has not been mentioned between 2020 and now (Accessed 1/10/25). While this doesn't mean a stump has developed, it may suggest that a stump contributes to pain six weeks after surgery.

I had a relatively smooth recovery for 18 months post-surgery. However, symptoms reappeared, and it became clear that I had developed a stump neuroma well after the six-week mark. The success rate of my surgery, initially around 85%, dropped to 70% over time. Now, nine years later, I continue to live with my stump neuroma.

As a former podiatric surgeon who has treated many patients, I can assure you that this issue is not uncommon.

You can read my article on metatarsalgia on this site.

Why Does This Happen?

Several factors can contribute to the development of a stump neuroma:

• Inadequate resection of the nerve.

• Scar tissue forming around the nerve end.

• Unusual excessive regenerative healing.

  
  

Differential Diagnosis

When evaluating stump neuroma, consider the following:

• Hypersensitive scar line.

• Slow-healing wound.

• Delayed healing wound.

• Infection.

• Inclusion cyst.

  
  

Surgical Technique and Its Implications

The surgical approach significantly influences the occurrence of stump neuromas. The highest incidence is associated with an approach from the top of the foot, while the lowest occurs when the approach is made through the sole. The sole approach provides better exposure but carries its own risks, such as skin scarring and corn formation.

Corn formation from an incision made under the foot for a Morton's Neuroma. From Morton's Neuroma Podiatrist Turned Patient. Tollafield. 2025.

Symptoms from a Stump Neuroma

While the risk of developing a stump neuroma is low, the impact is around 3, meaning it can interfere with walking comfort. A good analogy is having a stone in your shoe. Early on, the nerve sends pulsing signals that mimic the original problem.

The first step in managing this condition is to assess your footwear. Ensuring that your shoes have adequate width and depth is crucial. Any compression on the metatarsals can trigger those unpleasant signals, as the nerve is easily stimulated.

What Decisions Can Be Made?

Here are some options to consider for managing stump neuroma:

• Orthoses, insoles, and metatarsal pads.

• Steroid injection.

• Sclerosing agent (ethanol).

• Radiofrequency ablation.

• Cryosurgery.

• Surgical revision.

  
  

The first decision is to determine how manageable the problem is and how frequently it affects your daily life. It's essential to be realistic about your footwear choices. Well-fitted shoes with a thicker sole can often provide more relief than any treatment.

An orthosis can be beneficial if it's well-designed and doesn’t take up too much space inside the shoe.

Ethanol Injection: A Cautionary Tale

I underwent an ethanol injection under local anaesthetic. The pain was intense for 48 hours and required ibuprofen for relief. At that time, I evaluated my foot at about 60% recovery, three years post-surgery, and decided to postpone revision surgery.

This is not a technique I would recommend. The presence of scar tissue makes the procedure uncomfortable, and the resulting tissue doesn’t benefit significantly from this sclerosing agent.

Early steroid injection is more effective because it can soften scar tissue, reducing the impact of collagen-based scars. However, the benefits diminish if used later.

While surgical revision is a viable option, some patients may still face challenges. For example, a 50-year-old former nurse experienced less-than-ideal results, even after the remaining nerve end was cleared. Her scar line remained sensitive for nearly a year.

My own research, while writing the second edition of my book—Morton's Neuroma: A Podiatrist Turned Patient—allowed me to explore the entire scope thoroughly. With access to Huddersfield University library, I reviewed numerous scientific reports, and there is a case for radiofrequency ablation or cryosurgery as potential options to alleviate pain from a stump neuroma.

Recommendations as a Patient

Avoid surgery unless absolutely necessary. Early treatment is always preferable. Clinicians may hesitate to take advice, often due to the fear that we know more about the potential consequences of treatment.

Today, I manage my stump neuroma well enough to enjoy walking and using a fitness centre with the help of orthoses and the right shoes. If my symptoms worsened, I would not hesitate to explore radiofrequency ablation or cryosurgery.

I hope my articles and book provide valuable support to those seeking information and guidance.

Morton's Neuroma. 2nd Ed. 2025. Available from Amazon Books.

Thank You for Reading 'Stump Neuroma' by David R Tollafield

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