From the Guidelines
Treatment for Morton's neuroma should begin with conservative approaches, including wearing wider, low-heeled shoes, using custom orthotic inserts or metatarsal pads, and taking over-the-counter pain medications like ibuprofen or naproxen, as these methods have been shown to reduce pain and inflammation 1. When considering treatment options, it's essential to prioritize conservative management before moving to surgical intervention.
- Initial steps include wearing shoes with adequate toe box space to reduce pressure on the affected nerve.
- Custom orthotic inserts or metatarsal pads can help redistribute pressure away from the neuroma.
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) can reduce pain and inflammation. For more targeted relief,
- corticosteroid injections (typically methylprednisolone or dexamethasone mixed with lidocaine) directly into the affected area can provide temporary relief lasting weeks to months.
- Physical therapy focusing on foot stretching exercises and massage may help alleviate symptoms.
- Alcohol sclerosing injections (4% alcohol solution) administered in a series of 4-7 treatments spaced 7-10 days apart have shown effectiveness in some patients. If conservative treatments fail after 3-6 months,
- surgical options include either neurectomy (removal of the affected nerve segment) or neurolysis (releasing pressure on the nerve), with the choice depending on the individual's specific condition and severity, as informed by the most recent and highest quality studies, such as those published in the Journal of the American College of Radiology 1. Most patients experience significant improvement with conservative management, though complete symptom resolution may require a combination of approaches tailored to the individual's specific condition and severity.
From the Research
Treatment Options for Morton's Neuroma
The treatment options for Morton's neuroma can be categorized into conservative and surgical methods.
Conservative methods include:
- Corticosteroid injections: Studies have shown that corticosteroid injections can be an effective treatment for Morton's neuroma, with a high success rate in alleviating symptoms 2, 3.
- Shoe modifications and orthoses: This method can also provide relief, although it may not be as effective as corticosteroid injections 3.
- Ultrasound-guided injection therapies: These therapies, including steroid and alcohol injections, have been shown to be a cost-effective strategy compared to proceeding directly to surgical neurectomy 4.
- Infiltrative treatment: Substances such as capsaicin, corticosteroids, sclerosing solutions, and hyaluronic acid can be used in injections to treat Morton's neuroma, with varying degrees of efficacy 5.
Surgical methods include:
- Surgical neurectomy: This involves the removal of the affected nerve and can be considered if conservative treatments are unsuccessful 4, 6.
- Excision of the neuroma: This method has been recommended as the initial treatment of choice in some studies, although it is generally considered a last resort 6.
Effectiveness of Treatment Options
The effectiveness of these treatment options can vary depending on the individual case and the severity of the condition.
- Corticosteroid injections have been shown to be effective in alleviating symptoms in 90% of patients 2.
- Ultrasound-guided injection therapies have been found to be a cost-effective strategy, with a high success rate in reducing pain and improving quality of life 4.
- Infiltrative treatment has been shown to be effective in reducing pain, with capsaicin producing a significant reduction in VAS score 5.
- Surgical methods can also be effective, although they are generally considered a last resort due to the potential risks and complications associated with surgery 6.