How is Morton’s Neuroma Treated?
- Steroid Injections
Cortisone injections into the Morton’s Neuroma are the first line of treatment recommended by physicians. A significant reduction in pain is temporarily observed immediately following the injection.
Although a relatively safe treatment, rare reactions are observed, possibly more related to the anesthetic used in combination. Generally every time the injection is given it becomes less effective and the duration of benefits is decreased.
Because cortisone injections mask the inflammation and pain, they are rarely if ever, a permanent option in the treatment of Morton’s Neuroma.
Anti-Inflammatory medication can be helpful in the early stages of this progressive condition but falls way short of the help required as it advances over time. Prednisone dose packs can provide noticeable relief in moderate to advanced cases.
Inflammation is created with every step we take, so greater amounts of medication are required with diminished benefits. Oral narcotics won’t control the pain when this condition is in the advanced stages. The common side effects of pain meds often only complicate the problem.
- Physical therapy
Because many physical therapy modalities will help reduce inflammation they can be a helpful treatment option for Morton’s Neuroma.
Because PT does not treat the cause of the inflammation, that occurs as we walk, frequent treatments are necessary with diminishing results. Time and cost restraints are associated with this treatment option that will provide minimal and temporary benefits.
Most physicians understand that walking activity somehow aggravates the Morton’s Neuroma condition. They know that orthotics can change the way we walk and are used to treat other conditions believed to be caused or aggravated by the way we walk.
Only about half of the foot specialists recommend orthotics as a treatment option for Morton’s Neuroma. Your specialist knows that the orthotics they prescribe are generally an out-of-pocket expense to the patient, and that they are not a good treatment option for Morton’s Neuroma anyway, because they don’t work.
If they do help for a while, relief is minimal and temporary. Many doctors recommend orthotics even though they rarely work long term, because the alternative is surgery, and they want to exhaust all conservative options first.
- Alcohol Injections
Over the last 25 years, foot specialists have desperately searched for another effective alternative before surgery. A series of injections containing a toxic chemical that can kill nerve tissue was thought to be less invasive than surgery yet kill the nerve and stop the pain.
This treatment is an unpredictable attempt to ablate the intermetatarsal nerve, and stop the pain. There is minimal to no guarantee that after as many as 10 painful injections, any or all of the nerve will be ablated. What is also not clear is how much damage to the good tissue is done by this toxic chemical.
From both my personal experience using this treatment and consultation with many patients who have experienced this treatment, I fail to see any long term value. I do see the definite potential for toxic tissue reactions associated with the application of this treatment. It is difficult for me to treat a Morton’s Neuroma patient once they have had a series of failed OH injections.
- Surgery (Ablative Procedures)
Surgical excision is the most definitive ablative treatment option for Morton’s Neuroma. Radio-frequency ablation and Cryroablative procedures are newer alternatives to surgical excision. Pros and cons for all ablative procedures are debatable.
Short and long term benefits of all ablative procedures are not well documented. What is certain is that if the ablative procedure used by your surgeon WORKS PERFECTLY, overall and long term it will fail.
Are there conservative, OTC treatments I can try for Morton’s Neuroma?
Anti-inflammatory and pain medications are the first DIY treatments patients try and are helpful short-term in the early stages of the condition. More commonly, patients self-treat by first eliminating shoes with a heel. Later, they purchase bigger and wider shoes, with an enlarged toe box to minimize the compression on the inflamed neuroma.
At some point, most all Morton’s Neuroma patients try a metatarsal arch pad. 50 percent who try it find the pad causes pain. The other 50 percent report it provided the only help they got. Either way, the metatarsal arch pad is not enough.
Many patients end up wearing support sandals, like Vionics, Fit Flops, or Birkenstocks. The support they provide limits a small amount of pronation, and the sandal design decreases compression.
DIY Approaches to Treating Morton’s Neuroma Pain
- Cushioned surface
In the early stages of Morton’s Neuroma, patients find that a softer walking surface helps to control the nerve pain. Patients find that if they avoid hard surfaces they can mitigate the symptoms.
Use of cushioned insoles and standing mats will decrease symptoms at the beginning of this progressive condition. As this condition becomes more advanced, even the softest and most cushioned walking surfaces will provide minimal help with Morton’s Neuroma pain.
- Decrease Compression
When Morton’s Neuroma pain is in the earlier stages, patients will tell me that if they could avoid the compression of a shoe full time, they would have no problem whatsoever. They report that if they could go barefoot, or wear flip-flops and open sandals full time, it would be sufficient to stop most of the nerve pain.
Most physicians and shoe salesmen know to recommend bigger wider shoes to decrease the compression. Patients purchase shoes two full sizes bigger than the shoe size they wore when their feet quit growing. As this medical condition advances, even full-time use of completely non-compressive shoe gear fails to stop the pain aggravated by weight-bearing activity.
- Arch Support
As this condition progresses and pain is more frequent, it becomes apparent that arch support plays a critical role in the prevention of painful nerve symptoms. Patients make a change in shoe gear at some point during the progression of this disabling condition, to include those with built-in longitudinal support. Most patients try metatarsal arch supports and half of them find them helpful, the other half find them problematic.
Over time most patients gravitate toward a variety of shoes and inserts that provide longitudinal and metatarsal arch supports. By the time they call me, most patients are wearing a variety of support sandals including, Birkenstocks, Orthoheels, Vionics, or both custom and over the counter orthotics used in a stable running shoe.
Some patients are quick to tell me that although full-time use of these non-compressive and supportive shoes did stop the pain for a while, they “quit working” and the pain returned. Many patients tell me they continue to wear them full time as they are not working well enough.
- Decrease activity
Most patients control or diminish the symptoms of this condition by avoiding weight-bearing activities. One of the first things to change for women is a decrease in heel height and compressive shoes. After that, one weight-bearing activity after another is eliminated, to minimize Morton’s Neuroma pain.
When Should I Seek Treatment?
The point at which you consult a doctor for Morton’s Neuroma pain is a personal choice dependent upon your level of comfort in seeking help. Unfortunately, when caught early, the diagnosis is more difficult and less obvious.
Other conditions like stress fractures, arthritis, plantar plate tears, capsulitis, tendonitis, and Morton’s Neuroma are all grouped into a common diagnosis called metatarsalgia.
It doesn’t matter if you catch this condition early or late, if you remain active the condition will worsen over time and fail to respond to both conservative and invasive techniques.
To complicate the issue further, some doctors do not like to make the diagnosis of Morton’s Neuroma. Both the physician and the insurance companies see red flags when making a Morton’s Neuroma diagnosis.