What are the treatment options for Morton's neuroma?

From the Guidelines

Treatment of Morton's neuroma typically begins with conservative approaches, including wearing wide, comfortable shoes, using custom orthotic inserts or metatarsal pads, and taking over-the-counter pain medications, before considering surgical options. The goal of treatment is to reduce pressure on the affected area and alleviate symptoms. According to the American College of Foot and Ankle Surgeons 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated).

Some key considerations for treatment include:

• Wearing wide, comfortable shoes with a low heel and adequate toe box to reduce pressure on the affected area
• Using custom orthotic inserts or metatarsal pads to redistribute weight away from the neuroma
• Taking over-the-counter pain medications, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), to reduce pain and inflammation
• Applying ice for 15-20 minutes several times daily to help manage symptoms
• Considering physical therapy focusing on foot strengthening and stretching exercises to be beneficial

For persistent cases, a healthcare provider might recommend corticosteroid injections directly into the affected area, which can provide relief for weeks to months. However, it's essential to note that local injections of corticosteroids are not recommended according to the American College of Foot and Ankle Surgeons 1. If conservative treatments fail after 3-6 months, surgical options include decompression (releasing structures pressing on the nerve) or neurectomy (removing the affected nerve segment). Surgery has a success rate of 70-85% but may result in permanent numbness in the affected toes. Morton's neuroma is caused by thickening of tissue around a nerve between the metatarsal bones, usually between the third and fourth toes, resulting from compression or irritation, which explains why reducing pressure on this area is fundamental to treatment.

It's also worth noting that the most recent and highest quality study on this topic is not directly provided in the given evidence, but based on the available information, the above treatment approach is recommended.

From the Research

Treatment Options for Morton's Neuroma

The treatment options for Morton's neuroma include:

• Conservative measures, such as orthotics and anti-inflammatory medication, although these often have limited efficacy 2
• Minimally invasive ultrasound-guided procedures, including:
  • Infiltration of the area with a corticosteroid and local anesthetic 2, 3
  • Chemical neurolysis with alcohol or radiofrequency thermal neurolysis 2
  • Infiltrative type I collagen injections 4
  • Sclerosing alcohol injections 3, 5
  • Hyaluronic acid injections 6
  • Capsaicin injections 6
• Surgical neurectomy, which may be considered if other treatments are unsuccessful 2, 5

Efficacy of Treatment Options

The efficacy of these treatment options varies, with some studies suggesting that:

• Ultrasound-guided injections can produce significant and long-lasting pain reduction 2, 3
• Infiltrative type I collagen injections can lead to complete remission of symptoms 4
• Corticosteroids and sclerosant injections can be effective in reducing pain related to Morton's neuroma 6
• Capsaicin injections can produce a significant reduction in VAS score 6

Cost-Effectiveness of Treatment Options

The cost-effectiveness of these treatment options has also been studied, with one analysis suggesting that:

• A trial of ultrasound-guided injection therapies is a cost-effective strategy compared to proceeding directly to surgical neurectomy 5