Morton’s neuroma is a thickening or swelling of the nerve between the small bones of your forefoot. The nerve becomes swollen because it is trapped between the heads of the small bones. We think the trapping is caused by abnormal foot biomechanics and by wearing the wrong footwear. One treatment option is a Morton’s Neuroma injection. Is an ultrasound-guided Morton’s Neuroma steroid or cortisone injection effective and right for you?
What are the Common Features of Morton’s Neuroma?
Patients typically describe pain in the sole, usually between the toes. Pain is often described as a feeling of a stone in a shoe. It can be like an ache, sharp, or burning. Excessive walking or running can usually worsen pain. In some cases, numbness or pins-and-needles sensations radiate into the toes.
When your doctor examines you, there is tenderness between the toes. In addition, a click and pain can be felt when squeezing the toes together. It is essential to exclude other causes of forefoot pain, such as plantar plate rupture, MTP joint synovitis and foot stress fractures.
In general, it is essential to confirm a correct diagnosis with imaging. MSK ultrasound shows thickening and swelling of the nerve between the toes. In more complex cases, MRI is useful to rule out other causes of foot pain, such as stress fractures, toe joint inflammation, or plantar plate rupture.
What are the treatment options?
There are various ways to treat Morton’s neuroma. Some simple common treatments include:
- Changing footwear from tight to loose and ensuring it is not too small.
- A simple off-the-shelf orthotic can support the medial arch and reduce the load on the neuroma.
- Strengthening the foot muscles and stretching tight calf muscles can help reduce pressure on the neuroma.
- A referral to a podiatrist can help with more complex cases. Custom-fitted orthotics can help rebalance forefoot forces and reduce pressure on the Morton’s neuroma.
If Simple Measures Fail, Consider a Steroid Injection for Morton’s Neuroma.
Some patients have persistent pain despite these simple measures. A cortisone injection for Morton’s neuroma effectively reduces pain in these cases. A steroid injection is generally better with ultrasound due to greater accuracy. We can target the exact location by directing a small needle to the nerve swelling and scar tissue site. Typically, we recommend 1-2 Morton’s neuroma steroid injections, spaced about 2 months apart.
Morton’s neuroma steroid side effects
Although well-tolerated, Morton’s neuroma cortisone injections have side effects. These include cortisone flare, infection, skin atrophy, depigmentation, and damage to structures around the neuroma, such as ligaments or plantar plates. Generally, we reduce these risks by using ultrasound, which improves injection accuracy. Moreover, we use a less potent corticosteroid, such as Depo-Medrol, which reduces soft-tissue side effects. Also, you should only get an injection from a qualified doctor with experience injecting Morton’s Neuroma under ultrasound.
Alcohol injection for Morton’s Neuroma
Side effects of alcohol injections for Morton’s neuroma
Other injections, such as alcohol or phenol, have been used with mixed success. The aim is to destroy the nerve rather than reduce swelling. However, some reports of soft tissue destruction with these toxic injections have been reported. One study noted skin necrosis after alcohol injections with a higher concentration of alcohol is more likely to lead to side effects. Importantly, you should have these alcohol injections done under ultrasound to avoid damaging other structures.
In addition, a technique called cryoablation is also used with some success.
Finally, surgery is an option if all simple measures fail, including one or two cortisone injections. However, it is essential to understand that surgery may leave patients with permanent toe numbness. Also, not all surgical cases are successful.
Commonly asked questions about Morton’s Neuroma:
Are cortisone injections for Morton’s neuroma painful?
While an injection into the foot can be painful, we can make the Morton’s neuroma injection more tolerable by following simple principles. First, ultrasound guidance improves accuracy, leading to less soft-tissue damage. Second, a dorsal approach (or entry from the top of the foot) is less sensitive and more tolerable. If you’re considering a steroid injection for Morton’s neuroma, you should see a doctor experienced in ultrasound-guided injections.
Are there any conditions where you should be cautious about cortisone injections for Morton’s neuroma?
Yes. People with dark skin should be warned about the potential for skin depigmentation after a cortisone injection for Morton’s neuroma. The presence of hammer toes indicates that the plantar plate has been weakened. Injecting cortisone near a hammer toe might cut the plantar plate, worsening the toe deformity.
What happens if Morton’s Neuroma is left untreated?
This condition is benign and does not necessarily get worse. Simple treatments, such as changing footwear or using orthotics, can improve symptoms. In many cases, pain may settle without the need for injections or surgery.
Do compressive socks help Morton’s Neuroma?
We don’t think so. Generally, we suggest getting a wider, more stable shoe. Overall, compression will often make it worse.
Can Morton’s Neuroma come back after surgery?
No. But sometimes, surgery does not fix the pain even though Morton’s Neuroma is completely excised. So, you must be aware that surgery is not 100% successful.
Can you walk after Morton’s neuroma injection?
We suggest reduced walking for at least a few days after the injection. Regular ice and anti-inflammatory medications can help with the cortisone flare. You should avoid running for about a week after the injection.
Final word from Sportdoctorlondon about Morton’s Neuroma
Morton’s neuroma is a common cause of foot and toe pain. Generally, an ultrasound can pick up a neuroma. You should try simple treatments first before considering a cortisone injection for Morton’s neuroma. If you’re considering an injection, you should see a doctor with experience in Morton’s neuroma injection.
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