Treatment of Morton's Neuroma
Conservative treatment with corticosteroid injections should be the first-line therapy for Morton's neuroma, with 0.05-0.1 mL of triamcinolone acetonide injected beside (not into) the neuroma, achieving symptom relief in approximately 90% of patients. 1, 2
Initial Conservative Management
Start with corticosteroid injections as primary treatment:
- Inject small volumes (0.05-0.1 mL) of triamcinolone acetonide at multiple points around the neuroma, not directly into it 1
- This technique minimizes risk of fat and dermal atrophy that occurs with direct intralesional injection 1
- Clinical success rates reach 90% with this approach 2
- Corticosteroid injections demonstrate significantly better patient satisfaction compared to footwear modifications alone at 1,6, and 12-month follow-up intervals 3
Adjunctive Conservative Measures
Combine injections with supportive therapies:
- Footwear modifications with orthoses can be used alongside injections, though injections alone are more effective 3
- At 12-month follow-up, 82% of patients treated with steroid injections had complete or partial pain relief versus 63% with shoe modifications alone 3
- Rest, padding, and anti-inflammatory medications provide additional symptomatic support 4
Alternative Injection Therapies
If corticosteroids fail or are contraindicated, consider:
- Capsaicin injections (51.8% VAS score reduction) 5
- Alcohol sclerosing injections (well-tolerated, though efficacy requires further research) 5
- Hyaluronic acid injections (well-tolerated, efficacy needs additional study) 5
- All infiltrative therapies show no serious adverse events 5
Surgical Intervention
Reserve surgery for conservative treatment failures:
- Surgical excision through dorsal approach is indicated only when conservative interventions (including corticosteroid injections) fail to provide adequate relief 2, 6
- Careful patient selection and pre-operative counseling are essential for surgical success 6
Diagnostic Confirmation Before Treatment
Confirm diagnosis with imaging:
- Ultrasound (90% sensitivity) or MRI (93% sensitivity) are preferred diagnostic modalities 4, 7
- Ultrasound allows real-time clinical correlation during examination 4, 7
- Obtain radiographs first to exclude other causes of webspace pain (osteoarthritis, Freiberg's infraction, stress fractures) 7
Common Pitfalls to Avoid
- Do not inject directly into the neuroma - this increases risk of fat atrophy and dermal complications 1
- Do not use large single injections - multiple small injections (0.05-0.1 mL) around the neuroma are superior 1
- Do not proceed to surgery without adequate trial of conservative treatment - 90% of patients respond to injections 2