Morton's neuroma - preparation for procedure

Important things to remember when you attend your first appointment

Always bring the pair of shoes that most aggravate your pain. This is very important as the clinic sometimes undertakes diagnostic injections which are only helpful if you have shoes which you know will bring on your pain quickly!

Always bring insoles and pads that have been made or bought to treat your neuroma. The Centre will not perform cryosurgery on a patient who has not tried some form of conservative care such as insoles, pads or footwear change. If you wish to buy a pair of insoles to try at a local chemist before you attend then please calling the centre for more advice on this.

Always bring your scans or medical reports if you have these, especially if you hope to have treatment on the day of your consultation. Ideally send them to us before you attend.

Do not drive to the centre as you may need a diagnostic injection in which case you will not be able to safely drive home. If it is your left foot that is affected and you have an automatic car that this is usually acceptable Please note that patients must rest on the back seat of the car with their foot elevated immediately after cryosurgery.

Prior to your appointment you will be sent a comprehensive surgery information pack. This contains our foot surgery information booklet which provides information on podiatric surgery, including training and qualifications. It is important that you read this as it also cover the possible risks associated with surgery.

You will be asked to sign and send us a form prior to your appointment which confirms that you have read the relevant information leaflets pertaining to cryosurgery. The practise prefers to not treat patients on the day of their consultation when this is possible. We do appreciate however that some patients have travelled from afar and Mr McCulloch may be able to perform the procedure on the day if you fulfil the necessary criteria. Whether we proceed with an operation is entirely up to the discretion of Mr McCulloch and key factors which would steer this decision include;

1. Confirmation that your symptoms are indeed consistent with an interdigital neuroma. If you are travelling from far then it is obviously in your interest to make sure you have the correct diagnosis. Ideally you should have an MRI or ultrasound scan report from a consultant radiologist.
   
   In some instances Mr McCulloch may not agree with the diagnosis you have been given by another practitioner. Sometimes more than one neuroma may be present in which case a diagnostic injection can help with the diagnosis. This can often be performed during the consultation and in some instances a positive response may then allow for cryosurgery to take place.
   
   Sometimes patients present with more than one condition where foot instability has led to neuroma symptoms in combination with other pathologies. In such instances cryosurgery may not be the best treatment option or if performed, the patient will be carefully counselled on the fact that some symptoms from other causes may remain.
2. Confirmation that conservative care has been tried. All patients must have tried conservative care for a reasonable period and this largely consists of insoles / orthoses and footwear change. The centre would not expect you to have necessarily tried a steroid injection.
3. Patients with a more complex medical history may require a more extensive medical work up prior to cryosurgery. Where they are under another consultant such as a neurologist, rheumatologist or pain specialist, Mr McCulloch will often first wish to liaise with these specialists before proceeding with cryosurgery. Having stated this, the centre often treats higher risk patients as they may be far more suited to minimally invasive cryosurgery than open surgery.