From the Guidelines
Treatment for Morton's neuroma should begin with conservative approaches, prioritizing wide, comfortable shoes, custom orthotic inserts, and over-the-counter pain medications, as these methods can effectively reduce pressure and alleviate symptoms. According to the most recent and highest quality study 1, imaging techniques such as MRI can play a significant role in diagnostic and therapeutic decisions, with a sensitivity of 87% and specificity of 100% in evaluating patients with metatarsalgia and Morton's neuroma.
When considering treatment options, it is essential to prioritize methods that reduce pressure on the affected nerve and address inflammation and pain. Some key considerations include:
- Wearing wide, comfortable shoes with a low heel and soft sole to reduce pressure on the affected nerve
- Using custom orthotic inserts to redistribute weight and relieve pressure on the neuroma
- Taking over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) to reduce pain and inflammation
- Icing the affected area for 15-20 minutes several times daily to decrease swelling
- Modifying activities to avoid high-impact activities and those requiring tight footwear
For persistent symptoms, a podiatrist may administer a corticosteroid injection directly into the affected area, which can provide relief for weeks to months. However, it is crucial to note that local injections of corticosteroids are not recommended as an initial treatment option, as stated in the American College of Foot and Ankle Surgeons guidelines 1. If conservative treatments fail after 3-6 months, surgical options such as decompression or neurectomy may be considered, although these may result in permanent numbness in the affected toes.
From the Research
Treatment Options for Morton's Neuroma
- Non-surgical interventions, such as corticosteroid or sclerosing injections, have been found to be effective in reducing pain and improving treatment success rates 2
- Manipulation/mobilisation and extracorporeal shockwave therapy have also been reported to be effective in reducing pain 2
- A comparative analysis of conservative versus surgical treatment of Morton's neuroma found that surgical excision may be the initial treatment of choice 3
- A systematic review of the treatment of Morton's neuroma found that operative treatment had better outcomes than conservative treatment 4
Nonsurgical Treatments
- Corticosteroid and local anaesthetic injection (CS+LA) may result in little to no difference in pain and function when compared with local anaesthetic injection (LA) alone 5
- Ultrasound-guided (UG) CS+LA probably reduces pain and increases function when compared with non-ultrasound-guided (NUG) CS+LA 5
- UG CS+LA may increase satisfaction compared with NUG CS+LA 5
Surgical Treatments
- Plantar incision neurectomy (PN) may result in little to no difference for satisfaction and adverse events when compared with dorsal incision neurectomy (DN) 5
- PN and DN have different adverse event profiles, with PN including hypertrophic scaring and foreign body reaction, and DN including missed nerve, artery resected, and wound infection 5