Nerve Decompression vs. Neurectomy: Know Your Options
Nerve Decompression vs. Neurectomy: What's the Difference?
If you’ve been told you need surgery for Morton’s neuroma, understanding your surgical options is essential. These are not equivalent procedures — and the choice between them has lasting consequences.
Nerve Decompression Surgery
Nerve-preserving. The nerve stays in place.
Decompression surgery releases the tight ligament and fibrous tissue compressing the interdigital nerve — without removing the nerve itself. The nerve is preserved, and the source of the compression is eliminated.
Advantages:
- Nerve is preserved — no permanent numbness
- Lower risk of stump neuroma (painful nerve regrowth)
- Faster recovery — walking in a surgical shoe within days
- 85% long-term success rate in appropriate candidates
- Revision is possible if needed
Best for:
Patients who have not had prior surgery, whose neuroma is confirmed on imaging, and who meet clinical criteria for the procedure.
Neurectomy (Nerve Removal)
Nerve-removing. The nerve is excised.
Neurectomy involves cutting and removing the affected nerve. It eliminates the nerve entirely — along with all sensation in the affected area permanently. It cannot be reversed.
Disadvantages:
- Permanent numbness in the affected toes
- Risk of stump neuroma — a painful nerve regrowth ball at the cut end
- If stump neuroma develops, revision surgery is significantly more complex
- Cannot be undone
- Recurrence rates vary widely across studies
When it may be appropriate:
Patients with severe, long-standing neuromas who are not candidates for decompression, or those with prior failed decompression.
Dr. Bregman’s Philosophy: Preserve First
“Neurectomy is irreversible. Once the nerve is removed, you cannot get it back. If a patient is a candidate for decompression, that is always the first surgical option I offer — because preserving the nerve preserves options.”
— Dr. Peter J. Bregman, DPM
Over 1,000 nerve decompression procedures. 85% long-term success rate. Patients travel nationally and internationally for this approach.
Are You a Candidate for Decompression?
Not every patient is a candidate for nerve decompression. A thorough evaluation — including clinical examination and ultrasound — is required to determine the appropriate approach. Factors Dr. Bregman evaluates include:
- Size and location of the neuroma on imaging
- Duration and severity of symptoms
- Prior treatment history (injections, orthotics, prior surgery)
- Patient activity level and goals
- Presence of any concurrent foot conditions