From the Guidelines
The latest treatment for Morton's neuroma typically begins with conservative approaches, such as wearing wider shoes with lower heels and using metatarsal pads, before considering more invasive options like corticosteroid injections or surgical interventions. The initial management of Morton's neuroma involves reducing pressure on the affected nerve and managing pain and inflammation. Over-the-counter pain medications like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) can help manage pain and inflammation 1.
Conservative Management
- Wearing wider shoes with lower heels to reduce pressure on the affected nerve
- Using metatarsal pads to redistribute pressure
- Over-the-counter pain medications like ibuprofen or naproxen to manage pain and inflammation
Minimally Invasive Options
- Corticosteroid injections (typically methylprednisolone or dexamethasone mixed with local anesthetic) directly into the affected area to reduce inflammation and pain for several months
- Alcohol sclerosing injections (4% alcohol solution, administered in a series of 4-7 injections spaced 7-10 days apart) to destroy the painful nerve tissue
- Radiofrequency ablation, which uses heat to disrupt the nerve, is another minimally invasive option gaining popularity
- Cryoablation, which freezes the nerve, is also emerging as an effective treatment
Surgical Options
- Neurectomy (removal of the affected nerve)
- Nerve decompression to reduce pressure on the nerve
It's worth noting that the use of imaging techniques like MRI and US can aid in the diagnosis of Morton's neuroma, with MRI being a sensitive and reliable method to evaluate patients with metatarsalgia and Morton's neuroma 1. However, the treatment approach should prioritize conservative management and minimally invasive options before considering surgical interventions.
From the Research
Treatment Options for Morton's Neuroma
The latest treatments for Morton's neuroma include:
- Orthotics
- Steroid injections
- Surgical excision, usually performed through a dorsal approach 2
- Non-surgical treatments such as corticosteroid injection, alcohol injection, extra-corporeal shockwave therapy (ESWT), radiofrequency ablation (RFA), cryoablation, capsaicin injection, botulinum toxin, orthosis, and YAG laser therapy 3
- Ultrasound-guided (UG) corticosteroid and local anaesthetic injection (CS+LA) versus non-ultrasound-guided (NUG) CS+LA 4
- Plantar incision neurectomy (PN) versus dorsal incision neurectomy (DN) 4
Efficacy of Treatment Options
- Corticosteroid injections have shown a statistically significant reduction in mean VAS over all their studies (p < 0.01), with 50% success at 12 months 3
- Alcohol injection has shown promising short-term pain-relieving results, but long-term effectiveness is limited, with only 29% of patients remaining symptom-free at 5 years 5
- UG CS+LA probably reduces pain and increases function when compared with NUG CS+LA 4
- PN may result in little to no difference for satisfaction or adverse events compared with DN 4
Key Considerations
- Careful clinical examination, patient selection, pre-operative counselling, and surgical technique are key to success in the management of Morton's neuroma 2
- The certainty of the evidence for most treatment options is low, and future trials should improve methodology to increase certainty of the evidence 4