How do I know if I have one or more MNE in my foot?

The doctor should do a clinical exam and try to elicit a positive pinch test (nerve is pinched from above and below and it hurts) and selective nerve blocks of each potential nerve entrapment area. This may have to be done on separate visits.

How long should one wait for decompression surgery?

This varies but probably between 6-12 months of consistent symptoms.

What kind of doctor should I see in the USA?

Well, preferably one who has had additional peripheral nerve surgery training whether it was with the AENS or with a fellowship or a proper training course by surgeons who are skilled at the procedure. Usually this means a podiatrist just by volume but there are also orthopedic doctors and plastic surgeons. Surprisingly, here in the USA neurosurgeons are not good choices for this.

What is the difference between open or closed decompression?

Open is about a 1-2 inch incision on the top of the foot and the nerve is seen under magnification and any scar or fibrosis can be removed if present using micro-surgical techniques. Closed means through a small 2mm incision or endoscopically where the scar or fibrosis cannot be removed both are very successful and have a near zero percent chance of a stump neuroma.

What if I had many injections or cryoablation or radio frequency ablation can I still have decompression?

Yes but the success rate will drop depending on the damage done.

How do you know if the pain after a neurectomy is a stump or just normal?

You really can’t tell but if by 6 months you are not better then a stump is likely the issue.

Why isn’t there more doctors doing decompression and success rates?

The answer is essentially money and dogma. It is engrained into the system that neurectomy works just fine and that is simply not true! There are studies out there that show over 83% success rates with decompression and the failure rates of neurectomy as high as 40%. There is no money to be made by companies to promote the surgery so that is why there aren’t more studies or any social media surrounding it.

Questions from people suffering from this condition below:

Q: What is the difference between a scarred nerve and a swollen one?

Swelling is usually an early sign during the development of MNE and scarring comes later.

Q: Will decompression surgery get rid of the lump feeling under the foot?

In most cases yes but in about 25% no it will not go away but the pain does.

How do I know if I have one or more Morton’s neuroma in my foot?

Diagnosis requires a hands-on clinical exam. Your physician will attempt to elicit a positive Mulder’s sign — compressing the forefoot from side to side while pressing upward between the metatarsal heads to reproduce the characteristic click and shooting pain. Selective nerve blocks, where a small amount of anesthetic is injected precisely into each potential entrapment zone, confirm which nerve (or nerves) are involved. Because multiple nerves can be entrapped simultaneously, each space may need to be tested on separate visits to isolate the source accurately. Imaging such as ultrasound or MRI can support the diagnosis but should never replace a thorough clinical exam.

What is the difference between a scarred nerve and a swollen one?

A swollen nerve (early-stage MNE) is enlarged from chronic mechanical irritation but has not yet undergone significant internal damage. At this stage the nerve is inflamed and compressed but the nerve fibers remain relatively intact — making it highly responsive to decompression. A scarred nerve has progressed further: repeated trauma has caused internal fibrosis (scar tissue within and around the nerve sheath), which strangles the nerve fibers over time. Scarred nerves take longer to recover after decompression and may not fully resolve numbness, though pain relief is still achievable in most cases.

What percentage of Morton’s neuromas will go away on their own or with conservative treatment?

Research suggests that only about 20–25% of Morton’s neuroma patients achieve lasting relief with conservative care alone — things like wider shoes, metatarsal pads, orthotics, and anti-inflammatory medications. The remaining 75–80% continue to experience pain that worsens over time. Corticosteroid injections provide temporary relief for many patients but do not address the underlying nerve entrapment and can cause tissue damage with repeated use. If conservative treatment has not produced significant improvement after 3–6 months, a surgical evaluation with a nerve specialist is warranted to prevent permanent nerve damage.

How long should one wait before considering decompression surgery?

Generally speaking, if consistent symptoms persist beyond 6–12 months despite conservative care, decompression surgery becomes an appropriate next step. Waiting longer than that risks allowing the entrapment to progress from a swollen nerve to a scarred one — a shift that makes full recovery more difficult. Patients who undergo decompression earlier in the disease course tend to have faster healing, better pain relief, and more complete return of sensation. If symptoms are severe and rapidly worsening, it is reasonable to consider surgery sooner rather than waiting the full year.

What kind of doctor should I see for Morton’s neuroma in the USA?

Seek a physician who has completed additional peripheral nerve surgery training — through the AENS (American Society of Peripheral Nerve), a dedicated fellowship, or hands-on training with surgeons skilled specifically in nerve decompression. By volume, podiatrists perform the most Morton’s neuroma decompression procedures in the United States, but qualified orthopedic surgeons and plastic surgeons with peripheral nerve training can also be excellent choices. Neurosurgeons, despite their name, are generally not the right fit for foot nerve conditions. The key question to ask any surgeon is: “How many nerve decompressions do you perform per year and what are your outcomes?”

Will decompression surgery get rid of the lump feeling under my foot?

In the majority of cases, yes — the sensation of a lump or pebble under the ball of the foot resolves after decompression as the nerve shrinks back toward its normal size. However, in approximately 25% of cases the physical lump sensation may persist even though the pain resolves. This typically occurs when the nerve has been chronically enlarged and has developed significant internal fibrosis. The good news is that even when the lump remains, patients almost universally report dramatic improvement in pain, burning, and numbness — which are the symptoms that most affect quality of life.

What is the difference between open and closed decompression?

Open decompression involves a 1–2 inch incision on the top of the foot, giving the surgeon direct visualization of the nerve under surgical magnification. This approach allows removal of any surrounding scar tissue or fibrosis using microsurgical techniques — an important advantage in revision cases or when prior treatments have caused scarring. Closed decompression is performed through a much smaller 2mm incision or endoscopically, without direct nerve visualization. Both approaches release the transverse metatarsal ligament effectively and carry a near-zero risk of stump neuroma formation, which is the primary complication associated with neurectomy (nerve removal).

Can I have decompression surgery after a neurectomy (nerve removal)?

Unfortunately, no — once the nerve has been surgically removed through neurectomy, decompression is no longer an option for that nerve because there is nothing left to decompress. If you are experiencing pain after a neurectomy, the most likely culprit is a stump neuroma: the cut end of the remaining nerve has formed a painful ball of scar tissue. Treatment for a stump neuroma is different from decompression and may include targeted injections, nerve ablation, or surgical revision of the stump. This is one of the strongest arguments for choosing decompression over neurectomy as a first surgical option.

Can I still have decompression after injections, cryoablation, or radiofrequency ablation?

Yes — decompression is still possible after these treatments, but each one carries the potential to reduce your overall success rate. Corticosteroid injections, especially repeated ones, can cause fat pad atrophy and tissue damage around the nerve. Cryoablation and radiofrequency ablation create controlled injury to the nerve tissue and may result in internal scarring that persists even after the ligament is released. The more prior interventions a patient has had, the more complex the nerve’s condition tends to be — but many patients who have exhausted these options still achieve significant pain relief through decompression with an experienced specialist.

How do you know if pain after a neurectomy is from a stump neuroma or just normal healing?

It is genuinely difficult to distinguish early on, because some discomfort, altered sensation, and nerve sensitivity in the first weeks after neurectomy is expected as tissues heal. However, if pain is worsening rather than improving, or if significant pain persists beyond 6 months after surgery, a stump neuroma is the most likely explanation. Stump neuromas typically produce pain that is focal, often reproduced by direct pressure at the surgical site, and may be accompanied by a shooting or electric quality. Diagnostic nerve blocks at the stump site can help confirm the diagnosis before committing to further treatment.

Why aren’t more doctors performing decompression, and why are success rates not more widely known?

The honest answer comes down to money and institutional inertia. Neurectomy (nerve removal) has been the standard of care for decades, and changing that default requires both individual surgeon retraining and a shift in what is taught in medical schools and residency programs. Unlike pharmaceutical treatments or implantable devices, decompression surgery has no industry backing — no company profits from promoting it, so there is little financial motivation to fund large-scale trials or marketing campaigns. Yet the existing data is compelling: studies show decompression success rates above 83%, while neurectomy failure rates can reach 40% or higher. More patients and physicians need access to this information.

Explore More

Morton’s Neuroma Symptoms Explained — A detailed look at burning pain, numbness, the Mulder’s click test, and when to seek specialist care.
Nerve Decompression vs. Neurectomy — A side-by-side comparison of the two main surgical approaches and why decompression is Dr. Bregman’s first recommendation for appropriate patients.
Pain After Morton’s Neuroma Surgery — Still hurting after a previous neurectomy? Learn about stump neuroma, why it happens, and what treatment options exist.
Get a Second Opinion Before Surgery — Dr. Bregman provides specialist evaluations for patients seeking a nerve-preserving alternative or who’ve had a failed prior procedure.

Morton’s Neuroma FAQ | Common Questions Answered by a Nerve Specialist