What are the treatment options for Morton's neuroma?

From the Guidelines

Morton neuroma treatment should initially focus on conservative measures, including wearing wide, comfortable shoes, using orthotic inserts, and managing pain with over-the-counter medications, as these approaches can effectively reduce symptoms and improve quality of life. When considering treatment options, it is essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. According to the American College of Foot and Ankle Surgeons, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1.

Some key considerations for treatment include:

• Wearing wide, comfortable shoes with a low heel and good arch support to reduce pressure on the affected nerve
• Using over-the-counter pain medications like ibuprofen or naproxen to manage pain and inflammation
• Custom orthotic inserts or metatarsal pads to redistribute pressure away from the neuroma
• Physical therapy techniques, including massage, ultrasound therapy, and stretching exercises, to help manage symptoms

It is also important to note that local injections of corticosteroids are not recommended as an initial treatment option 1. If conservative treatments fail after 3-6 months, surgical options may be considered, including releasing the tissue surrounding the nerve or removing the affected nerve segment entirely. However, surgery has a success rate of 70-85% and may result in permanent numbness in the affected toes. Recent studies have highlighted the importance of imaging techniques, such as MRI and US, in the diagnosis of Morton’s neuroma, with MRI showing high sensitivity and specificity in evaluating patients with metatarsalgia and Morton’s neuroma 1.

From the Research

Morton Neuroma Treatment Options

• Conservative methods:
  • Shoe modifications and orthoses 2
  • Steroid injections 2, 3, 4, 5
  • Alcohol injection 3
  • Extra-corporeal Shockwave therapy (ESWT) 3
  • Radiofrequency Ablation (RFA) 3
  • Cryoablation 3
  • Capsaicin injection 3
  • Botulinum toxin 3
  • Orthosis 3
  • YAG Laser Therapy 3
• Surgical methods:
  • Plantar incision neurectomy (PN) 4
  • Dorsal incision neurectomy (DN) 4

Efficacy of Treatment Options

• Steroid injections:
  • May result in little to no difference in pain and function compared to local anaesthetic injection 4
  • Probably reduces pain and increases function when guided by ultrasound 4
  • Showed a statistically significant reduction in mean VAS over all studies (p < 0.01) 3
• Shoe modifications:
  • May not be as effective as steroid injections in providing pain relief 2
• Surgical treatments:
  • May result in little to no difference in satisfaction and adverse events compared to other surgical methods 4

Outcomes and Satisfaction

• Patient satisfaction was significantly better in the group treated with steroid injections than those treated with shoe modifications 2
• Corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores in most studies 5
• Almost 30% of subjects eventually underwent operative treatment after receiving corticosteroid injections due to persistent pain 5