10/20/2020
At least once a month I encounter a new patient for a second opinion about their planned Morton's neuroma surgery. Many of these patients state they failed to get significant relief from a steroid injection on at least one attempt. I am usually suspicious that either the diagnosis is incorrect or that the injection was done blind (without the use of ultrasound images to guide the injection around the neuroma).
Most of these second opinions that I see did not have the benefit of ultrasound guided injection. Of course, before I recommend a more permanent solution (decompression vs removal vs ablation) I do recommend to try at least one ultrasound guided injection to the neuroma.
There are two reasons why I recommend this treatment. First, I perform a detailed scan of the anatomy be sure that a Morton's neuroma exists, and to evaluate the other structures in the area for pathology. Second, performing the injection with the direct visualization of the nerve allows the injection to be as close to the nerve as possible without traumatizing the nerve.
Usually, an injection of steroid to a Morton's Neuroma under direct visualization with ultrasound will be more effective than a blind injection. Furthermore, many of these patients had significant and long lasting pain relief.
My experience is validated in the published research: Peter Morgan, Wendy Monaghan, Simon Richards. A systematic review of ultrasound-guided and non-ultrasound-guided therapeutic injections to treat Morton's neuroma. JAPMA 2014 Jul;104(4):337-48.
Eric Rockmore is Morton's Neuroma specialist utilizing minimally invasive techniques.
