From the Research
For the treatment of Morton's neuroma, the recommended dosage of steroid is 40 mg of triamcinolone acetonide, as it has been shown to provide statistically significantly better functional and pain outcomes compared to other treatments, such as hyaluronic acid injections, as demonstrated in a recent study 1. The injection is typically administered directly into the affected intermetatarsal space where the neuroma is located, usually between the third and fourth metatarsal heads. Some key points to consider when administering steroid injections for Morton's neuroma include:
- Using a local anesthetic, such as 1% lidocaine or 0.5% bupivacaine, in combination with the steroid to minimize discomfort during the procedure
- Performing the injection under ultrasound guidance to ensure accurate placement of the steroid, as this has been shown to lead to greater long-term improvement compared to blind injections 2
- Administering a series of up to three injections spaced 4-6 weeks apart, as some patients may require multiple injections to achieve optimal relief
- Advising patients to rest the foot for 24-48 hours after injection and monitor for potential side effects, such as temporary pain flare-up, skin discoloration, or fat pad atrophy with repeated injections
- Considering alternative treatments, such as surgical excision, if symptoms do not improve after 2-3 injections, as suggested in a review of current concepts in the treatment of Morton's neuroma 3.