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. Triamcinolone (Kenalog) 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
    3. Ropivacaine 0.25 to 0.5% 1 to 2 ml
  • Technique
  • Anatomic
  1. Patient position
    1. Supine position with knee flexed over towel roll
    2. Foot in neutral position
  2. Anatomic Landmarks
    1. Interdigital space between Metatarsal heads
    2. Mark area maximal tenderness
  3. Ultrasound guidance
    1. High frequency linear probe positioned in short axis over the dorsal foot at interdigital space
    2. Inject out of plane
  4. Sterilize local skin with Betadine or Hibiclens
  5. Insert needle into skin at point of maximal tenderness
    1. Needle insertion is into the dorsal foot, between the Metatarsal heads
    2. Angle needle 45 degrees proximally toward heel
    3. Do not inject into plantar fat pad
      1. Avoid injecting deep to the intermetatarsal Muscles (fullness)
  6. 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]
  3. Wilcox (2026) Am Fam Physician 113(5): 431-9 [PubMed]