The Barn Clinic was the first in the UK and Europe to offer Cryosurgery for Morton’s Neuroma.
We offer unrivalled experience of a highly skilled, difficult technique. Cryosurgery and pain relief is our passion.
Cryosurgery for Morton's Neuroma FAQ's
Cryosurgery and Cryotherapy both refer to a modern form of Morton’s neuroma treatment which was introduced to the UK by Mr. Robin Weaver, podiatrist at The Barn Clinic. For more information, please see our cryosurgery for Morton’s neuroma page.
Yes! We are the leading centre in Europe offering podiatry Cryosurgery for Morton’s neuroma and have performed more treatments than anywhere outside of North America. To date, we have performed over 2000 procedures with no reported complications or infections.
Your treatment will take place in a bright, clean and airy treatment room, and will be carried out by Mr Robin Weaver, with assistance from another member of staff. Both Robin and his assistant will ensure you feel at ease during your appointment and will often chat to you throughout the treatment.
You will be sat up (or laid back on request) in your own clothes, and you are welcome to bring a family member into the treatment with you.
As with many minor procedures in which anaesthetic is required, the first numbing injections are the most uncomfortable part of the treatment, but following these injections you wont feel any pain or discomfort. Some patients report feeling a slight vibration from the probe, approximately 100 patients report feeling a cold sensation during a small portion of the treatment.
The full length of the treatment will typically last around 40 – 60 minutes, including administering anaesthetic and dressing the area after
Unlike Morton’s neuroma excision surgery, Cryosurgery can be performed in a clinic, and there is virtually no risk of the patient developing a stump neuroma following treatment. Cryosurgery also has a much shorter recovery period than other treatment options, and has an extremely high success rate.
An important benefit of cryosurgery treatment for Morton’s Neuroma to appreciate is that the essential aspects of the nerve, the epineurium and the perinerium, remain intact therefore preventing the possibility of formation of a stump neuroma on the foot which is a common occurrence with other surgical options.
Cryosurgery does not completely destroy the nerve, and therefore does not usually result in permanent numbness of the foot or toes.
This is a concern that sometimes arises due to the confusion between Cryosurgery for external skin lesions, such as warts and verruca, and Cryosurgery for nerve related issues such as Morton’s neuroma and Bursa.
Cryosurgery is a blanket term used to refer to treatment methods that utilise extremely cold temperatures and ice, but methods, techniques and technology vary greatly according to what it is that’s being treated.
Cryosurgery for the treatment of skin lesions, such as wart and verruca, typically does cause damage to surrounding tissue, largely due to the freezing agent that is being used and the method of application. This is often the origin of the misunderstanding that this will also be the case when using Cryosurgery for the treatment of Morton’s Neuroma. The reality is in fact quite the opposite!
Cryosurgery treatment for Morton’s Neuroma and Bursa is an incredibly precise procedure in which the freezing is applied a carefully and accurately, causing little to no damage to the surrounding tissue and structures. This precision and accuracy is achieved with both experience and a refined technique, and importantly, with constant ultrasound image guidance. Ultrasound guidance allows us to firstly place the probe in the optimum position, and secondly to detect and prevent any such potential damage before it occurs.
Cryosurgery is under no circumstances be performed blind (without image guidance).
In any event, freezing adjacent tissue for the very short period of time used to treat neuroma and bursa would cause no lasting effects other than mild short-term discomfort. Cryosurgery has been used to treat nerve related problems in the human body since 1970’s. Sir Sydney Sunderland, in 1968 demonstrated that after a nerve is frozen, the basic architecture of the nerve remains intact and stump neuroma formation does not occur. The nerve is typically able to regenerate at a rate of 1 – 1.5 mm/week.
Cryosurgery for Morton’s Neuroma now has a very well established safety records that exceeds the records of all alternative treatment options.
The only similarity between Cryosurgery and Radio Frequency (RFA) is that both treatments aim to cause deliberate injury to nerves, typically via a ‘key-hole’ access. However, method of injury, the type caused, and effects of such injury are entirely different.
Nerve injury is classified by severity of injury on a scale of 1-5, with 1 being the least and 5 being the most severe type of injury. (1)
Cryosurgery treatment for Morton’s Neuroma is caused by using exteme cold temeratures and results in Class 3 damage. Class 3 damage is ‘reversible’ as ultimately the nerve reverts back to normal. This is because the basic architecture or ‘scaffolding’ of the nerve is still preserved allowing for ‘organised ‘repair of the nerve which recovers typically at a rate of 1mm per week. (2)
RFA treatment for Morton’s Neuroma uses a thermo-electric current to cause the intended nerve injury, which results in Class 5 damage to the nerve. Class 5 damage results in total destruction of the architecture of the neve and causes irreversible loss of function of the nerve.
We don’t offer RFA here at The Barn Clinic, and therefore would not like to comment on success rates, risks and outcomes. There are however plenty of resources available to the public regarding RFA outcomes.
1.Sunderland S. Nerve and nerve injuries. 2nd ed. New York: Churchill Livingstone; 1978).
2. Hsu M, Stevenson FF. Wallerian degeneration and recovery of motor nerves after multiple focused cold therapies. Muscle Nerve. 2015;51(2):268-75).
A small percentage of patients experience mild discomfort whilst having local anaesthetic injection. This generally lasts a few seconds. Once the local anaesthetic has been administered there is no pain felt during the treatment.
As soon as 48 hours in some cases, but usually 3-4 days following successful Morton’s neuroma treatment.
You should not start running again until at least six weeks after cryosurgery treatment for Morton’s neuroma. This is significantly shorter than the recovery period for traditional Morton’s neuroma surgery. For cryotherapy for athletes, please see our cryosurgery for athletes page.
Patients with circulation disorders, particularly to the hands and feet require careful assessment and are not always suitable candidates for cryosurgery. Similarly, patients with serious medical conditions are assessed on a case-by-case basis.
Yes, such patients will often experience total relief after a second treatment.
Yes, there is no reason why Morton’s neuroma excision surgery cannot be performed if required.
Mr. Weaver was the first UK podiatrist to be trained in the United States in the use of percutaneous Cryosurgery. He was trained by the most experienced U.S. Cryosurgery trainer, who has trained approximately 50% of the podiatrists who now perform Cryosurgery in the United States. On the completion of his training, he was described as being “one of the most competent and knowledgeable professionals I have ever trained”. Mr. Weaver introduced percutaneous Cryosurgery to the UK in 2008 and and has since gone on to train other professionals including Podiatric surgeons from the Society of Chiropodists and Podiatrists.
His qualifications are recognised by both the Institute of Chiropodists and Podiatrists (IoCP) and The Society of Chiropodists and Podiatrists (SoCP). Mr Weaver is fully insured and registered with the HPC (Health Professionals Council), and is recognised to provide cryosurgery by all UK medical insurance companies.
Since 2008 Mr Weaver has performed well over 3000 procedures and has also developed new protocols for the treatment of stump neuromas which are now being adopted by podiatrists in the United States.
Mr. Weaver is the most experienced and qualified person to perform cryosurgery in Europe, and as such he sees patients from all parts of the UK and the rest of the world, including patients who have travelled from countries as far as China, Australia and the United States.
Yes. The vast majority of our patients travel quite a way to visit the clinic. For this reason, we are happy to offer a consultation and treatment on the same day. Your consultation will take place in the morning, and your treatment in the afternoon. We do require you to leave the premises for a few hours to comply with informed consent regulations and to consider all the information provided to you during your consultation. In order to arrange a same day consultation and treatment, we do require a deposit to secure your appointments. Mr Weaver specialises in Cryosurgery for Morton’s Neuorma, and therefore Cryosurgery is available Tuesday – Friday (inclusive). Both your consultation and treatment will take place at the same location.
A lot of the major providers cover the treatment costs of cryosurgery with Mr. Weaver at The Barn Clinic for Morton’s neuroma however insurance polices can vary so please check with your provider.
Please note: We do not accept patients for cryosurgery through BUPA or AXA PPP.
If you believe you have a Morton’s neuroma or foot neuroma we offer treatment at our clinic in Sheffield, UK. Please contact us for further information and to book an appointment. We also operate a Satellite clinic based in London. If you would prefer your treatment to take place at our London clinic, please call The Barn Clinic to discuss.
Conservative Treatment Options
Acupuncture can provide temporary pain relief for some patients, however it will not address the underlying issue, which is the fact that the nerve in enlarged and being compressed by the surrounding structures. Typically, acupuncture reduces pain levels by approximately 10-20%. Patients that have recent steroid injections should not have acupuncture needles inserted into the interspace that had the steroid injection. This is because there is an increased risk of abscess formation and infection.
The current evidence is that alcohol injections do not work. The treatment goal of alcohol injections is to ablate (destroy) the nerve and render it incapable of transmitting pain. The issue with alcohol injections is that for many patients the alcohol injections fail to ablate the nerve, and instead cause fibrosis of the nerve. This results in increased pain, with the fibrosis causing the nerve to enlarge even further. Due to the enlargement of the nerve following alcohol injections, and the further compression caused, this increases the risk of patients developing Morton’s neuroma in the adjacent interspace.
Alcohol injections are generally considered safe, but the outcomes are considered to be very poor.
Cortisone shots (also known as steroid injections) generally do help with Morton’s neuroma, especially if they are given under ultrasound guidance. However, the current thinking is that once the nerve or the neuroma has enlarged to beyond 5.5mm in diameter that they are rarely effective for more than 1-3 months. However, for smaller neuroma’s, they can sometimes shrink the neuroma.
There are specific foot-types that are predisposed to Morton’s neuroma, such as flat-footed (pronated), high arches (supinated), patients with bunions, and patients whose 2nd toe is longer than their big toe. For these particular foot types, orthotics can help treat the symptoms of Morton’s neuroma and sometimes prevent other neuromas from forming. A thorough podiatric consultation can provide more information as to your foot-type.
Excision Surgery / Neurectomy
Neuroma can grow back after excision surgery / neurectomy. This is what is known as a ‘Stump Neuroma’.
No. The advice is that you should not walk following Mortons Neuroma excision surgery. Crutches should be used for approximately 4 weeks post excision surgery. However, Cryosurgery patients can walk completely normally within 3-4 hours post treatment and during the first 2-3 hours post treatment cryosurgery patients should try to take approximately 60% of their weight through their heel.
Complete recovery from Morton’s neuroma excision surgery can take up to 12 Months. The initial surgical scar require stitches to be removed around around 2 weeks post excision surgery, and the scar can taken around 3 months to heel. Swelling can be present for around 6 months.
Most cases require 1 month off work after Morton’s Neuroma excision surgery. Job roles that require the patient to be particularly active can require 2-3 months off work. Cryosurgery patients are able to return to work after around 3 days post treatment.
Private Morton’s neuroma excision surgery can cost in the region of £2,000.00-£3,000.00. Morton’s neuroma excision surgery is not available at The Barn Clinic
Following morons neuroma excision surgery, patients do frequently experience varying degrees of pain following excision surgery, and generally patents are able to mange this pain with the use of prescription pain-killers.
Morton’s Neuroma excision surgery should be considered the option of last resort, due to the not insignificant risk of developing serious, life-long complications, such as stump neuroma. Some studies quote that 35-40% of patients will experience unacceptable levels of pain post excision surgery.
Shoes such as a Birkenstocks, Sketchers, and Fit-Flops are often very helpful for patients with Morton’s neuroma.
One of the best shoes on the market for Morton’s neuroma are zero degree heel shoes. This is because the heel generally doesn’t sit above the forefoot which in turn decompresses the neuroma, and they also tend to be supportive. A brand of zero-degree shoes we recommend is Altra.
A post-op shoe is recommend post excision surgery. They generally have, velcro straps that open up and allow for swelling, accommodate any bandages required and provide easy access into the shoe. They help to immobilise the foot during the initial recovery phase post excision surgery. Post-op shoes are not required post Cryosurgery, as only minimal dressing is required, there is very little swelling, and not requirement to inhibit normal foot function. Cryosurgery patients can wear their own shoes post treatment.
Self-Help / Home-Treatment / Lifestyle
In the early stages of Morton’s neuroma, patients often find that they can continue exercising, but with some degree of symptoms during and after the period of exercise. As the neuroma enlarges, and the condition develops, these symptoms become more pronounced and in turn restrict activity. Patients often have to switch from high-impact activity such as running, to lower impact exercise such a cycling and swimming.
Generally, when Mortons neuroma develop to a certain size, massage will not provide an improvement in symptoms. However, many neuroma patients have an accompanying condition called bursitis, and massage will frequently provide temporary relief for the symptoms of bursitis.
A high percentage of neuroma patients have an accompanying condition called bursitis, and frequent icing will often help calm the bursitis. Similarly many people with neuroma have co-exisiting conditions such as capsulitis, which can improved with topical icing
Symptoms of Morton’s neuroma can be improved at home by managing footwear choice, lifestyle amendments (ie. avoiding triggering factors such as running), massage and icing. For many patients, such lifestyle changes are not suitable, and many patients choose to undergo treatment for their Morton’s neuroma, such as Cryosurgery.
Morton’s Neuroma Information
With careful management, some patients are able to manage the symptoms associated with Morton’s Neuroma, to the point that they no longer experience pain. However, the neuroma will still remain if no treatment is undertaken.
A very small percentage of patient report pain radiating up into the leg.
Varying treatment options have varying rates of reoccurrence. When patients undergo cryosurgery, we are effectively ‘wiping the slate clean’ and returning the foot to how it was before the neuroma developed. However, this means that if the patient is to expose the feet to the same set of circumstances that caused the neuroma to develop initially, that it could recur. During your consultation we would work with you to identify these factors, and where possible, put preventative measures in place to avoid reoccurrence, such as prescription orthotics.
Mortons neuroma occur typically in the bottom of the foot (closest to the ground). However, neuromas can occur anywhere in the body if exposed to blunt trauma.
Yes, the swelling often results in a mild slaying of the toes. This is sometimes referred to as the ‘star trek’ sign, or more properly, the Sullivan’s sign.
X-Ray’s are useful for ruling out other sources of neuroma-like pain that can sometimes stem from bones. However, X-Rays themselves are unable to detect Morton’s neuroma.
If you feel a persisting intermittent clicking sensation, accompanied by burning, pins and needle, numbness in the forefoot/toes, it is highly likely that you have either Morton’s neuroma or bursitis. Please take our Morton’s Neuroma Likeliness Quiz here
Avoidance of tight-fitting / high-heeled shoes. Limiting high impact activity, such as running. Weight-management. Identifying high-risk foot-types and using orthotics for the relevant foot-types.
The most effective method of ‘removing’ a neuroma is Cryosurgery, in which the nerve is frozen and shrunk back to a normal size. This leaves the nerve intact and fully functional.
With careful lifestyle management, including footwear choices, reduction of high-impact exercise and sport, massage and icing, some patients are able to manage the symptoms associated with Morton’s Neuroma to the point that they no longer experience pain.
The popular treatment options for Morton’s Neuroma include, Orthotics, Steroid Injections, and Cryosurgery.
There are multiple ways to diagnose a Morton’s neuroma. An experienced clinician can often make a diagnosis by taking a clinical history and performing a physical examination. The presence of a Mulder’s click is considered to be 96% sensitive for the presence of a Morton’s neuroma or bursitis. However, without ultrasound imaging a clinician will be unable to distinguish whether the symptoms are caused by bursitis, Morton’s neuroma or a combination of both.
Thankfully, for the majority of people, Morton’s Neuroma is not a disability. However, Morton’s neuroma can severely restrict quality of life, and limit enjoyment of passions, hobbies, recreational activities and often family life. The effects of Morton’s neuroma on patients lives should in no small way be underestimated. In our experience, Morton’s Neuroma suffers are often frustrated by the fact that the condition is not particularly well-known, and that non-sufferers generally have little idea of the level of pain and limitations that Mortons neuroma sufferers are subjected to. Morton’s neuroma can in some cases can lead to depression and anxiety.
Morton’s neuroma itself is not hereditary, but some of the predisposing foot types and conditions are.
If left untreated, Morton’s Neuroma is a permanent condition.
For most people, choice of footwear, regular low level repetitive mechanical irritation to the nerve (such as running), being over-weight, foot type and blunt trauma can all cause Morton’s neuroma. At a macro level, all of the above contribute to degeneration of the blood vessels that supply the nerve causing inflammatory changes, such as fibrosis and enlargement of the nerve.
Symptoms of Morton’s Neuroma include, numbness, pins and needles, burning, electrical shooting sensations, stone-in-the-shoe sensation, and a bunched-up-sock feeling. Some patients report that they feel like they have a bleeding cut between their toes.
Morton’s neuroma will persist if untreated, and in some cases will enlarge.
Footwear changes, lifestyle changes, reduced activity, orthotics, painkillers and anti-inflammatory medication, icing. Toe extension exercises and calf-stretching can also improve symptoms.
When measuring a Morton’s neuroma, the diameter of the neuroma is the most important measured as opposed to the length. Many consider a large neuroma would measure around 8-10mm in diameter.
A scar neuroma is another term for a stump neuroma. A scar / stump neuroma is a bulbous swelling at the site of where the nerve was cut.
Cryosurgery is considered the best treatment option for Morton’s Neuroma.
Symptoms of stump neuroma are very similar to the symptoms of a Morton’s neuroma, but of a much stronger magnitude and unlike Morton’s neuroma, they can be present when non-weight bearing.