From the Research
The initial treatment for Morton's neuroma-bursitis complexes within the left second and third intermetatarsal spaces should involve conservative measures, prioritizing corticosteroid injections as the most effective non-surgical option, as evidenced by the most recent and highest quality study 1. The treatment approach should start with activity modification, avoiding high-impact activities and tight or narrow footwear that compresses the forefoot.
- Use wide, cushioned shoes with a low heel and metatarsal pad support to reduce pressure on the affected nerves.
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) can help reduce inflammation and pain.
- Ice application for 15-20 minutes several times daily may also provide relief.
- Custom orthotic inserts with metatarsal pads specifically positioned to spread the metatarsal heads and reduce nerve compression are often beneficial. If these measures don't provide sufficient relief within 2-4 weeks, corticosteroid injections (typically methylprednisolone 40mg mixed with local anesthetic) into the affected intermetatarsal space may be considered, as they have been shown to be effective in reducing pain related to Morton's neuroma 2. These conservative approaches are recommended first because they address the mechanical compression and inflammation that cause symptoms, and approximately 80% of patients experience significant improvement without requiring surgical intervention 3. Ultrasound-guided corticosteroid and local anesthetic injection (UG CS+LA) has been shown to probably reduce pain and increase function for people with Morton's neuroma, compared to non-ultrasound-guided injections 1. It is essential to note that while other treatments like alcohol sclerosing injections have been used, their long-term effectiveness is questionable, and they may be associated with considerable morbidity 4. Therefore, prioritizing corticosteroid injections as part of the initial treatment plan, based on the most recent evidence, is crucial for managing Morton's neuroma-bursitis complexes effectively.