A Morton’s neuroma is a common, painful foot condition where the tissue surrounding an interdigital nerve thickens, often causing burning pain, numbness, or the sensation of walking on a small pebble, typically between the third and fourth toes. A corticosteroid injection is frequently used to address the inflammation and reduce the size of the enlarged nerve tissue. This article focuses on the pain level experienced during and immediately following the injection process.
The Cortisone Injection Experience
The pain experienced during a cortisone shot for Morton’s neuroma is described as a brief, intense discomfort rather than prolonged, severe pain. To minimize discomfort, the cortisone medication is combined with a local anesthetic, such as lidocaine. This anesthetic begins to numb the area immediately, reducing the sensation from the injection.
The procedure involves a sharp, momentary sting as the needle punctures the skin, followed by a deeper sensation. As the fluid—the mixture of corticosteroid and anesthetic—is injected into the tight space around the neuroma, patients often report feeling a distinct sensation of pressure or transient burning. Because the injection targets the nerve and the confined space between the metatarsal bones, the pressure felt can be more acute than a standard muscle injection.
Many practitioners use ultrasound guidance to ensure the medication is delivered precisely to the affected nerve. This guidance enhances accuracy, increasing effectiveness and reducing unnecessary tissue trauma. Although injecting a substance into a sensitive, inflamed nerve area is uncomfortable, the period of peak pain lasts only a few seconds. The numbing agent makes the overall pain level manageable, often described as low-level discomfort for the duration of the brief procedure. Patient anxiety and the specific technique used by the clinician are major factors influencing the perceived pain level.
Immediate Post-Injection Discomfort
Following the procedure, the local anesthetic immediately takes effect, providing a temporary absence of pain and numbness in the toes. This initial relief is short-lived, however, as the numbing agent wears off within a few hours. Once the anesthetic effect dissipates, it is common for patients to experience a distinct, temporary increase in pain.
This post-injection discomfort is known as a “cortisone flare,” which affects a small percentage of patients. A cortisone flare is caused by the crystallization of the steroid medication at the injection site, which irritates the surrounding tissues before the drug fully dissolves. Symptoms include localized aching, throbbing, or a bruised sensation, typically beginning within 12 to 48 hours after the shot.
This acute pain is a temporary reaction to the medication itself, not a sign that the treatment has failed. The flare-up subsides on its own within two to three days. Management involves resting the foot, applying ice packs to the injection site, and using over-the-counter pain relievers like acetaminophen or ibuprofen.
Expected Timeline for Pain Relief
The therapeutic benefit of the cortisone injection—the reduction of chronic neuroma pain—does not occur instantly. The corticosteroid is a potent anti-inflammatory agent, requiring time for its properties to take effect on the thickened nerve tissue. The initial pain relief experienced is solely due to the local anesthetic mixed with the steroid.
Patients should anticipate that true, sustained pain relief from the cortisone will begin within three to seven days following the injection. This timeline allows the steroid to fully suppress the localized inflammation and swelling around the neuroma. The duration of this therapeutic effect is highly variable among patients.
For some, the relief may last only a few weeks, while others experience significant improvement for several months. The severity and duration of the existing neuroma often influence how long the pain-relieving effects persist. If a patient experiences no improvement after one week, a second injection might be considered, though repeated injections are avoided to prevent potential tissue damage.