From the Research
Treatment for Morton's neuroma should begin with conservative approaches, prioritizing corticosteroid injections as the first-line management strategy, as evidenced by a recent study 1 showing a 90% success rate in alleviating symptoms.
Initial Treatment Options
- Wearing proper footwear with a wide toe box and low heels
- Using metatarsal pads or custom orthotics to reduce pressure on the affected nerve
- Activity modification to avoid aggravating activities
- Over-the-counter pain medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to manage pain and inflammation
Injections for Symptom Relief
- Corticosteroid injections (typically methylprednisolone 40mg mixed with local anesthetic) directly into the affected interspace can provide temporary relief, usually lasting weeks to months, and may be repeated up to three times with at least one month between injections 2
- Alcohol sclerosing injections (4% alcohol solution) administered in a series of 4-7 injections spaced 7-10 days apart represent another option
Alternative Therapies
- Physical therapy focusing on stretching exercises and strengthening the arch muscles may also help
- Mechanical Diagnosis and Therapy (MDT) has shown promise in a case series 3, but more research is needed to confirm its effectiveness
Surgical Intervention
- If conservative treatments fail after 3-6 months, surgical options include neurectomy (removal of the affected nerve segment) or neurolysis (releasing pressure on the nerve) 4
- Surgery typically provides permanent relief but carries risks including permanent numbness in the affected toes and potential development of a painful stump neuroma A cost-effectiveness analysis 5 suggests that a trial of ultrasound-guided injection therapies is a cost-effective strategy compared to proceeding directly to surgical neurectomy, supporting the use of injections as a first-line treatment.