Can Morton's neuroma resolve and then recur?

Can Morton's Neuroma Recur After Resolution?

Yes, Morton's neuroma can recur after initial resolution, particularly following conservative treatment, and even after surgical excision the condition can return or progress due to the nature of the underlying pathology.

Natural History and Recurrence Pattern

Morton's neuroma represents a mechanically-induced degenerative neuropathy rather than a true tumor, which explains its tendency to recur when the underlying mechanical stressors persist 1. The condition develops from chronic microdamage to the common digital nerve, most commonly affecting the third intermetatarsal space 1.

Why Recurrence Occurs

• Persistent mechanical stress from the excessive motion between metatarsals, the tethered nerve position, and continued weightbearing stress (especially with pointed or high-heeled shoes) can reproduce the pathology even after initial symptom resolution 1
• The nerve fiber degeneration and excessive intraneural fibrous tissue formation that characterize the condition can progress over time if mechanical factors are not addressed 1
• Conservative treatments provide temporary relief but do not eliminate the underlying mechanical cause, making recurrence common when treatment is discontinued 2

Recurrence After Different Treatment Modalities

Following Conservative Treatment

• Corticosteroid injections can provide significant pain relief but symptoms frequently return once the anti-inflammatory effect wears off 3, 2
• A meta-analysis showed corticosteroid injection decreased pain more than control (mean difference: -5.3 on VAS scale), but this represents temporary symptom control rather than cure 2
• Non-surgical interventions address symptoms but not the underlying pathology, explaining high recurrence rates 2

Following Surgical Treatment

• Even after neurectomy (surgical removal), recurrence can occur, though the mechanism differs from primary disease 1
• Neurolysis (nerve decompression without excision) has a 77% recurrence rate, making it an inferior option 4
• When painful recurring Morton's neuroma develops after initial surgery and does not respond to conservative treatment, removal through a plantar approach can provide lasting relief 1
• The interval between first symptoms and surgery averages 3.5 years, during which time the condition often worsens despite conservative measures 4

Clinical Implications

Common Pitfall to Avoid

• Do not assume resolution means cure - patients who experience symptom relief from conservative measures remain at risk for recurrence if they return to provocative footwear or activities 1
• The long natural history (average 3.5 years before surgery) demonstrates that symptoms typically wax and wane rather than permanently resolve with conservative care 4

Practical Management Approach

• For initial presentation: trial of conservative treatment including corticosteroid injections placed beside (not into) the neuroma using 0.05-0.1 mL triamcinolone acetonide 3
• Monitor for recurrence with ultrasound or MRI (sensitivity 90% and 93% respectively) if symptoms return 5, 6
• If symptoms recur after conservative treatment and significantly impact quality of life, surgical neurectomy through a dorsal approach provides definitive treatment with dramatic symptom relief 1
• For recurrence after initial surgery, consider plantar approach neurectomy for lasting relief 1