Morton's Neuroma: Conservative Management and Symptom Relief

Interdigital (Morton's) Neuroma: Non-Surgical Approaches

Perineural fibrosis of common plantar digital nerve (usually 3rd webspace). Not true neoplasm. Pain, burning, numbness, "pebble in shoe" sensation.

Conservative Measures (First-Line)

• Footwear: Wide toe box, low heel, cushioned sole. Avoid narrow, high heels.
• Metatarsal pads/domes: Placed proximal to metatarsal heads → splay heads, decompress nerve. Key intervention.
• Orthotics: Custom or OTC with metatarsal support.
• Activity modification: Reduce impact, avoid aggravating shoes.
• Ice massage: 10-15 min, 3-4x/day (roll frozen bottle).
• NSAIDs: Oral or topical for acute flares.

Adjunctive Therapies

• Physical therapy: Nerve glides, intrinsic strengthening, gait retraining, ultrasound/iontophoresis.
• Corticosteroid injection: Ultrasound-guided, 3rd webspace. Diagnostic + therapeutic. Limit 2-3/year (fat pad atrophy risk).
• Alcohol sclerosing injections: 4-30% alcohol; series of 3-7. Destroys nerve fibers. Success 60-80%.
• Radiofrequency ablation: Emerging, minimally invasive.

Exercises (Nerve Glides)

1. Sit, affected foot flat. Cross ankle over opposite knee. Pull toes toward shin (dorsiflex + evert) → stretch plantar nerve. Hold 30s.
2. Towel under lateral foot, pull toward tibia.
3. Gentle toe spreading, especially 3rd/4th.

Unproven / Low Evidence

• Vitamin B complex (unless deficient).
• Acupuncture (limited RCT data).
• Massage (temporary relief only).

Surgical Indications

Failed 3-6 months conservative. Neurectomy (open/endoscopic) or decompression. Success 80-85%; permanent numbness in webspace.

Diagnosis: Clinical + ultrasound/MRI. Rule out stress fracture, MTP synovitis, tarsal tunnel, radiculopathy.