Morton’s neuroma is a painful foot condition involving the thickening of tissue surrounding a digital nerve, most frequently located between the third and fourth toes. This enlargement is a degenerative process that causes burning, sharp pain, or a sensation like walking on a marble in the ball of the foot. Determining the “best” treatment depends on the severity of symptoms and the individual’s response to various interventions. Treatment typically follows a stepped progression, beginning with the least invasive methods and advancing to more definitive procedures if pain persists.
Initial Steps for Relief
The first line of defense involves conservative, non-invasive treatments aimed at reducing pressure and irritation on the affected nerve. A primary focus is modifying footwear to alleviate the compression that contributes to the nerve’s thickening. Shoes with a wide toe box are recommended because they allow the toes to spread naturally, reducing the squeezing force on the interdigital nerve.
Wearing low-heeled shoes is also advised, as high heels shift weight onto the forefoot, increasing pressure on the neuroma. Avoiding narrow, pointed-toe shoes is another effective change to prevent nerve irritation. These adjustments alone can provide complete or partial pain relief for many patients.
Beyond footwear, mechanical supports are used to redistribute pressure away from the painful area. Metatarsal pads, placed just behind the ball of the foot, lift and separate the metatarsal bones, which helps decompress the trapped nerve. Custom or off-the-shelf orthotics can also provide support and ensure even weight distribution across the foot.
Activity modification, such as resting the foot and avoiding activities that aggravate the pain, is another important step. For temporary relief from pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be taken orally. While these conservative measures are often the most common starting point, they must be consistently applied for several weeks before determining their effectiveness.
Injections and Advanced Minimally Invasive Options
When conservative measures fail to provide sufficient relief after several weeks, targeted medical procedures are considered next. Corticosteroid injections, often combined with a local anesthetic, are a common option to reduce inflammation surrounding the nerve. The corticosteroid decreases swelling, which can temporarily relieve the pressure and pain associated with the neuroma.
While effective in providing short-term pain relief, corticosteroid injections treat inflammation, not the nerve thickening itself. Patients often experience maximal pain reduction within one to three months following the injection. Due to potential side effects, only a limited number of these injections are recommended for the same site.
An alternative, more definitive, minimally invasive treatment is alcohol sclerosing injection, a form of chemical neurolysis. This procedure involves injecting a concentrated solution of ethyl alcohol directly into or around the neuroma, often guided by ultrasound. The alcohol chemically destroys the nerve tissue, causing it to degenerate and atrophy, eliminating the source of chronic pain.
Sclerosing therapy is administered as a series of injections, often requiring three to seven treatments spaced one to two weeks apart to achieve a successful outcome. This approach is favored by many because it can achieve a high success rate, potentially avoiding the need for surgery. The goal is to eliminate the nerve’s function in the area, which may result in temporary or permanent localized numbness.
Surgical Removal or Decompression
Surgery is reserved as a last resort when all non-surgical treatments, including injections, have failed to control the pain. The most common surgical procedure is a neurectomy, which involves surgically removing the affected section of the thickened nerve tissue. This definitive procedure removes the source of chronic pain.
An unavoidable consequence of neurectomy is permanent numbness in the portion of the toes supplied by the removed nerve. Most patients find this numbness more tolerable than the constant, sharp pain of the neuroma. The procedure is often performed on an outpatient basis, and recovery involves wearing a protective surgical shoe for several weeks.
The second primary surgical option is nerve decompression, sometimes called external neurolysis. This procedure aims to relieve pressure on the nerve by cutting surrounding structures, such as the transverse metatarsal ligament, without removing the nerve itself. Decompression is less invasive than a neurectomy and attempts to preserve nerve function, potentially avoiding permanent numbness.
Recovery from both surgical options requires a period of limited weight-bearing, often involving a surgical shoe or boot for two to four weeks. Patients can return to normal daily activities within three to six weeks, though full recovery for high-impact sports can take three to six months. While surgery offers a high chance of lasting relief, there is a risk of a painful stump neuroma or nerve entrapment in scar tissue forming post-operatively.