Procedure

Morton's Neuroma Injection

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Morton's Neuroma Injection, Interdigital Neuroma Injection

  • See Also
  1. Joint Injection
  2. Injectable Corticosteroid
  • Indications
  1. Morton's Neuroma refractory to other measures
  • Preparation
  1. Needle
    1. Gauge: 25 to 27
    2. Length: 1.0 to 1.5 inches
  2. Syringe: 3 to 5 ml
  3. Corticosteroid options
    1. Corticosteroid offers no benefit over Anesthetic injection alone (see efficacy below)
    2. Betamethasone (Celestone) 0.5 ml of 6 mg/ml
    3. Methylprednisolone (Solu-Medrol): 0.5 ml of 40 mg/ml
  4. Anesthetic
    1. Lidocaine 1%: 1 to 2 ml or
    2. Bupivacaine 0.25% or 0.5%: 1 to 2 ml
  • Technique
  1. Patient position
    1. Supine position with knee flexed over towel roll
    2. Foot in neutral position
  2. Landmarks
    1. Interdigital space between Metatarsal heads
    2. Mark area maximal tenderness
  3. Sterilize local skin with Betadine or Hibiclens
  4. Insert needle into skin at point of maximal tenderness
    1. Angle needle 45 degrees proximally toward heel
    2. Do not inject into plantar fat pad
  5. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion
  • Efficacy
  1. Better efficacy under Ultrasound guidance
  2. Anesthetic alone is as effective as if combined with coticosteroid
    1. Anesthetic alone injections also avoids adverse effects (soft tissue atrophy)
  3. References
    1. Matthews (2024) Cochrane Database Syst Rev 2(2):CD014687 +PMID: 38334217 [PubMed]
  • Adverse Effects
  1. Plantar fat pad atrophy
  • Management
  • Follow-up Instructions
  1. No stress to foot for 2 weeks after injection
  2. Examine again in 3 weeks post-injection
  • References
  1. Greene (2001) Musculoskeletal Care, AAOS, p. 480-1
  2. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]