What is the treatment for Morton's neuroma?

From the Guidelines

Treatment for Morton's neuroma should initially focus on conservative measures, including wearing open-backed shoes, using heel lifts or orthoses, taking NSAIDs, decreasing activity, performing stretching exercises, and weight loss if indicated, as these methods have been found to be beneficial in managing symptoms 1. When managing Morton's neuroma, it's essential to prioritize approaches that reduce pressure on the affected nerve and promote comfort.

• Key initial steps include:
  • Wearing open-backed shoes to reduce pressure on the area
  • Using heel lifts or orthoses to redistribute pressure
  • Taking NSAIDs to manage pain and inflammation
  • Decreasing activity to avoid exacerbating the condition
  • Performing stretching exercises to improve foot mechanics
  • Weight loss if indicated, to reduce overall pressure on the feet In contrast to other considerations, local injections of corticosteroids are not recommended 1, highlighting the importance of adhering to evidence-based guidelines in treatment selection. For cases that are acute or refractory, immobilization may be considered as a further conservative measure before exploring more invasive options. The goal of these treatments is to alleviate symptoms within six to eight weeks, at which point continued treatment is based on symptom resolution.

From the Research

Treatment Options for Morton's Neuroma

The treatment for Morton's neuroma can be categorized into conservative measures, minimally invasive procedures, and surgical excision.

• Conservative measures include:
  • Orthotics 2, 3, 4
  • Anti-inflammatory medication 2
  • Shoe modifications 3
• Minimally invasive procedures include:
  • Infiltration of the area with a corticosteroid and local anesthetic 2, 5
  • Chemical neurolysis with alcohol 2, 5
  • Radiofrequency thermal neurolysis 2
  • Capsaicin injections 5
  • Hyaluronic Acid injections 5
  • Sclerosant injections 5
• Surgical excision is usually performed through a dorsal approach 4, 6

Efficacy of Treatment Options

• Steroid injections have been shown to be effective in reducing pain, with 82% of patients experiencing complete or partial relief of pain at 12-month follow-up 3
• Capsaicin injections have been reported to produce a significant reduction in pain, with a VAS score reduction of 51.8% 5
• Corticosteroids have also been shown to be highly effective in reducing pain related to Morton's neuroma 5
• Surgical excision is recommended as the initial treatment of choice by some authors, with a high success rate 6