Steroid injections and local anesthetics may provide temporary, but not long-term, symptom relief. Evidence does not support the use of alcohol sclerosing injections for long-term relief.4

Surgical interventions

Although surgical nerve excision may provide pain relief for Morton’s neuroma, long-term subsequent paresthesiae and shoe limitations are common. In a 2008 study by Womack et that involved 120 patients, 50% had good or excellent outcomes, 10% had fair outcomes, and 40% reported poor outcomes.5


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TRENDING ON CPA: How to Overcome Pain Resource Challenges: Part 1 

As an alternative treatment, nerve decompression via endoscopy offers a minimally invasive option to address the pathology, while preserving nerve function.  In a 2010 study by Barrett et al, 95% of procedures performed in the third intermetatarsal space and 85% of those performed in the second intermetatarsal space had good-to-excellent outcomes for a 92% success rate.6

Data from 1979 study by Gauthier and colleagues that described decompressions performed on 304 neuromas indicated that 83% of outcomes were good, 14% fair, and 3% poor.7

Regardless of the intervention employed, the goal of treatment for Morton’s neuroma is consistent:  resolution of pain associated with this common and potentially debilitating condition.

Disclosures: Andrew Rader, DPM, received honoraria from and is a member of the speaker’s bureau for Organogenesis, D.N.E. SEAL External Fixation, and CE Lasers. He also received consulting fees from D.N.E SEAL External Fixation and is a stock shareholder in Fuse Medical.

References

  1. American Podiatric Medical Association.  Foot health. Available at: http://www.apma.org/learn/FootHealthList.cfm?navItemNumber=498. Accessed August 17, 2015.
  2. Bennett GL, Graham CE, Mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int. 1995;16:760-763.
  3. Saygi B, Yildirim Y, Saygi EK, Kara H, Esemenli T. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005;26(7):556-559.
  4. Gurdezi S, White T, Ramesh P. Alcohol injection for Morton’s neuroma: a five-year follow-up.  Foot Ankle Int. 2013;34(8):1064-1067.
  5. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital neuroma treated by surgical excision.  Foot Ankle Int. 2008;29:574-577.
  6. Barrett SL, Rabat E, Buitrago M, Rascon VP, Applegate D. Endoscopic decompression of intermetatarsal nerve (EDIN) for the treatment of Morton’s entrapment—multicenter retrospective review. Open J Orthop. 2012;2:19-24.
  7. Gauthier G. Thomas Morton’s disease: a nerve entrapment syndrome.  A new surgical technique. Clin Orthop Relat Res. 1979;142:90-92.

This article originally appeared on MPR