Morton’s neuroma is a thickening or swelling of a nerve between the small bones of the forefoot. The nerve becomes swollen because it’s trapped between the heads of these small bones, brought on by abnormal foot biomechanics and the wrong footwear. The most common site is between the 3rd and 4th toes. One effective treatment is a Morton’s neuroma injection.
What are the common features of Morton’s neuroma?
People with Morton’s neuroma typically describe pain in the sole, usually between the toes, often like having a stone in the shoe. The pain can be an ache, sharp, or burning, and excessive walking or running makes it worse. Some people notice numbness or a pins-and-needles sensation radiating into the toes.
On examination, there is usually tenderness between the toes, and a click can be felt when the toes are squeezed together. A recent paper suggests the thumb squeeze test is a very good way to detect a Morton’s neuroma.
It’s important to confirm the diagnosis with imaging. MSK ultrasound shows thickening and swelling of the nerve between the toes. In more complex cases, MRI helps rule out other causes of forefoot pain, such as a stress fracture or toe joint inflammation.
What are the treatment options?
There are several ways to treat Morton’s neuroma. Simple measures come first: changing from tight to loose-fitting footwear and making sure shoes aren’t too small. An off-the-shelf orthotic supports the medial arch and reduces the load on the neuroma. Strengthening the foot muscles and stretching tight calves also reduces pressure on the neuroma. A referral to a podiatrist helps in more difficult cases.
If simple measures fail: a Morton’s neuroma injection
Some people have persistent pain despite these simple measures. In these cases, a cortisone injection for Morton’s neuroma effectively reduces pain. The injection is far more accurate under ultrasound: by directing a small needle precisely to the site of nerve swelling, we target the exact spot. We usually recommend 1–2 injections, about two months apart.
Morton’s neuroma steroid side effects
Although well tolerated, cortisone injections have side effects, including skin thinning (atrophy), depigmentation, and damage to nearby structures such as ligaments. We reduce these risks by using ultrasound and a less potent type of cortisone. You should only have the injection from a qualified doctor experienced in injecting Morton’s neuroma under ultrasound.
Alcohol injection for Morton’s neuroma
Other injections, such as alcohol or phenol, have been used with mixed success. These aim to destroy the nerve rather than reduce the swelling. However, there have been a few reports of soft-tissue destruction with these toxic injections. A technique called cryoablation is also used with some success.
Surgery
Surgery is an option if all simple measures — including one or two cortisone injections — fail. It’s important to understand that surgery may leave you with permanent toe numbness, and not all surgeries are successful.
How much does a Morton’s neuroma steroid injection cost?
Dr Masci performs the Morton’s neuroma injection as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about Morton’s neuroma steroid injection
Why should a Morton’s neuroma injection be done under ultrasound?
Ultrasound lets the doctor place the needle precisely at the swollen nerve between the toes. This improves the injection’s accuracy and effectiveness, and reduces side effects — because the cortisone goes exactly where it’s needed rather than into the surrounding tissues.
How long does a Morton’s neuroma injection last?
It varies. A cortisone injection often relieves pain for several months, and we usually plan 1–2 injections about two months apart. Combining the injection with better footwear and orthotics helps the relief last longer.
Does a cortisone injection cure Morton’s neuroma?
It reduces nerve swelling and pain, which is enough to settle many cases — especially when paired with footwear changes and orthotics. It doesn’t always give permanent relief, though. Where injections don’t hold, nerve-destroying options (alcohol or cryoablation) or surgery are considered.
Is the Morton’s neuroma steroid injection painful?
Most people tolerate it well. Local anaesthetic is used, and because ultrasound places the needle accurately, the injection tends to be quick and well tolerated.
What happens if Morton’s neuroma is left untreated?
It’s a benign condition and doesn’t necessarily get worse. In many cases, simple treatments such as a change of footwear or orthotics improve the symptoms.
Do compression socks help Morton’s neuroma?
We don’t think so. A wider, more stable shoe is more helpful — compression around the forefoot often makes it worse.
Can Morton’s neuroma come back after surgery?
No — once excised, it’s gone. But surgery doesn’t always fix the pain, even when the neuroma is completely removed, so it’s important to know surgery isn’t 100% successful.
Final word from Sport Doctor London about the Morton’s neuroma injection
Morton’s neuroma is a common cause of pain in the foot and toes. Ultrasound reliably picks up a neuroma, and it’s best to try simple treatments before an injection. Where simple measures fail, an ultrasound-guided cortisone injection is an effective next step.
To discuss a Morton’s neuroma injection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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