Morton’s neuroma is a thickening or swelling of the nerve between the small bones of your forefeet. The nerve becomes swollen because of the nerve trapping between the heads of the small bones. We think the trapping is brought on by abnormal foot biomechanics and 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?
Typically, patients describe pain at the sole, usually between the toes. Often, pain is described as a feeling of a stone in a shoe. Pain can be like an ache, sharp, or burning. Usually, excessive walking or running can cause worsening pain. There is numbness or pins and needles radiating into the toes in some cases.
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 important to exclude other causes of forefoot pain, such as plantar plate rupture, MTP joint synovitis and stress fractures of the foot.
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 pain in the foot, 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-fitting to loose-fitting and ensuring footwear 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 the forces in the forefoot and reduce pressure on the Morton’s neuroma.
If simple measures fail, consider a Morton’s Neuroma steroid injection.
Some patients have persistent pain despite these simple measures. A Morton’s Neuroma cortisone injection 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. Generally, we recommend 1-2 Morton’s neuroma steroid injections about two 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 makes the injection more accurate. Moreover, we use less potent cortisone, such as depo-medrol, which lessens 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 toe numbness, which may be permanent. Also, not all cases of surgery 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 Morton’s neuroma injection more tolerable by following simple principles. First, using ultrasound guidance means that accuracy is improved, 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 possible skin depigmentation after a cortisone injection for Morton’s neuroma. The presence of hammer-toe means that the plantar plate has been weakened. Injecting cortisone near a hammer toe might cut the plant 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 like a change in footwear or orthotics can improve symptoms. In many cases, pain may settle without intervening with 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 injection. Regular ice and anti-inflammatory medications can help the cortisone flare. You should avoid running for about a week after injection.
Final word from Sportdoctorlondon
Morton’s neuroma is a common cause of pain in the foot and toes. Generally, ultrasound can pick up a neuroma. You should try simple treatments first before considering Morton’s neuroma cortisone injection. If you’re considering an injection, you should see a doctor with experience in Morton’s neuroma injection.
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