Morton’s Neuroma Injection

Morton’s neuroma injection treatment with steroid offers a specialized approach to alleviate plantar digital neuritis of the foot, commonly known as Morton’s neuroma.

This condition is characterized by intense burning pain or paraesthesia in the space between metatarsal heads, particularly between the third and fourth metatarsals.

Equipment Needed

• Syringe: 1 ml
• Needle: Blue, 23 gauge / 1.5 inches (30 mm)
• Kenalog 40: 20 mg
• Total volume: 0.5 ml

This condition typically involves the development of a distressing swelling in the common digital nerve below the transverse intermetatarsal ligament. It commonly occurs between third and fourth metatarsals, either between or slightly distal to the metatarsal heads.

Patients often report a history of burning pain, particularly at night, along with sensations of squeezing the heads or exerting excessive pressure on the nerve by hyperextending the toes. These symptoms are typically suggestive of this specific ailment.

See Also: Morton's Neuroma

Morton’s Neuroma Injection Technique

1. Position the patient in a supported seated position, ensuring that their foot is placed flat on a stable surface.
2. Identify and mark the tender area between the metatarsal heads. This area typically corresponds to the site of the inflamed neuroma.
3. Prepare the necessary injection equipment, including a sterile needle and a suitable solution for injection.
4. Insert the needle perpendicularly at the marked tender area, aiming to reach the affected neuroma.
5. During the injection, it is important to maintain proper needle placement and avoid any unintended tissue damage. As the needle is inserted, the patient’s feedback should be monitored closely.
6. If the patient reports a sharp burning sensation, it may indicate that the needle is in close proximity to a nerve. In such cases, it is advised to slightly withdraw the needle tip to avoid inadvertent nerve injury.
7. Once the needle is properly positioned, deposit the solution around the inflamed neuroma. The solution should be carefully administered to provide targeted relief and reduce inflammation.

The interdigital neuroma injection is commonly effective in alleviating symptoms; however, if the patient continues to wear thin-soled, excessively high heels, or other unsuitable footwear, there is a chance of symptom recurrence.

To mitigate compression after the injection, it is beneficial to use a small pad near the metatarsal head to elevate the bone during the initial weeks. If symptoms reappear, it is advisable for the patient to consult a foot surgeon to explore surgical options.

When administering injections near neural tissue, it is crucial to proceed with caution to avoid causing sudden sharp pain that could startle the patient upon nerve entry. It is important to deposit the drug surrounding the neuroma rather than directly into the nerve itself, as doing so could potentially cause permanent damage.

Steroid injection for Morton’s Neuroma using Ultrasound

Ultrasound can be used in Morton’s Neuroma injection and, therefore, appropriately direct therapeutic interventions, with good short-term clinical results.

In a study: With sonography, neuromas are clearly visualized as incompressible hypoechoic nodules replacing the normally hyperechoic web space fat. Neuromas were distinguishable from other causes of forefoot pain, such as metatarsophalangeal joint synovitis and intermetatarsal bursae. The sizes of the neuromas injected ranged between 4 and 19 mm.

Post Morton’s Neuroma injection, all neuromas displayed increased echogenicity and/or the appearance of fluid surrounding it, confirming localization of the therapeutic mixture.

References & More

1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
2. Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection–preliminary results. HSS J. 2007 Feb;3(1):44-9. doi: 10.1007/s11420-006-9029-9. PMID: 18751769; PMCID: PMC2504098.
3. Alexander, Leon. (2021). Microsurgical Neurolysis, Dorsal Transposition and Nerve Wrap of Morton’s Interdigital Neuroma: A Novel Technique. 2021. 10.37591/RRJoS.