Can Morton's neuroma go away on its own?

Rarely. Without treatment, the neuroma tends to progressively worsen. Shoe changes and orthoses can relieve symptoms, but infiltration is often necessary for a lasting result.

How many alcoholization sessions are needed?

Generally 2 to 3 ultrasound-guided alcoholization sessions, spaced 2 to 4 weeks apart. The long-term success rate is 70 to 85%, making it an excellent alternative to surgery.

Is Morton's neuroma infiltration painful?

The procedure is well tolerated. A slight burning sensation may be felt during injection of the local anesthetic. Post-injection pain is generally moderate and disappears within 24 to 48 hours.

Can you walk after a Morton's neuroma infiltration?

Yes, walking is possible immediately after the infiltration. It is advisable to avoid long walks, running, and inappropriate footwear for 48 to 72 hours following treatment.

When should surgery be considered for Morton's neuroma?

Surgery is considered after failure of well-conducted conservative treatments (orthoses, physiotherapy) and ultrasound-guided infiltrations (cortisone or alcoholization). It involves surgical removal of the neuroma.

Morton's Neuroma: Diagnosis, Conservative Treatments, and Ultrasound-Guided Injection

Morton's Neuroma: Understanding This Source of Foot Pain

Morton's neuroma (or plantar interdigital neuroma) is a frequent foot pathology affecting mainly the spaces between the toes, most commonly between the 3rd and 4th toes. It is a painful perineural fibrosis, often described as a "sensation of walking on a pebble."

Causes and Risk Factors

Morton's neuroma results from chronic compression of the interdigital nerve, leading to thickening of the connective tissue around the nerve. Risk factors include:

Wearing narrow-toed shoes or high heels
Activities with repeated impact (running, dancing)
Foot deformities (hallux valgus, flat feet or high arches)
Overweight

Characteristic Symptoms

Burning pain or electric shocks in the forefoot
Sensation of a foreign body (like a pebble or a fold in the sock)
Tingling in adjacent toes
Pain worsened by walking and relieved by rest
Relief when removing shoes and massaging the foot

Ultrasound Diagnosis

Musculoskeletal ultrasound is the first-line examination to confirm the diagnosis. It directly visualizes the thickening of the interdigital nerve (hyperechoic, oval-shaped) and measures its size. A Morton's neuroma is typically > 5 mm in diameter. Ultrasound also allows precise guidance of therapeutic infiltration.

Treatment Options

Conservative treatment (1st line):

Shoe modification (wide toe box, low heel)
Plantar orthoses with metatarsal pad
Physiotherapy and joint mobilization of the foot

Ultrasound-guided infiltrations:

Cortisone infiltration: reduces inflammation around the nerve. Effective in 60 to 70% of cases. Duration of 2 to 6 months
Alcoholization (sclerotherapy): injection of a concentrated alcohol solution that induces controlled fibrosis around the neuroma, reducing its size. 2 to 3 sessions spaced 2 to 4 weeks apart. Success rate of 70 to 85%

Surgery: reserved for cases refractory to well-conducted conservative treatments and infiltrations. The procedure involves surgical removal of the neuroma (neurectomy). Recovery takes 3 to 6 weeks.