There is limited evidence to suggest that steroid injections have long-term benefits for Morton’s neuroma patients. However, some patients do find them helpful, especially if the condition is associated with a larger bursitis. We would only ever perform a steroid injection if there is no evidence of weakness of the joints that lie adjacent to the neuroma.
We usually recommend cryosurgery over steroid injections because it is associated with fewer risks and complications, and we have encountered many patients who have developed the more serious complication of a capsular (joint) tear following a steroid injection.
Steroid weakens the capsular tissue, especially if there is already an underlying degree of instability, for example from a hammertoe. Capsular tears can be more difficult to treat than neuromas and they nearly always result in a toe deformity.
Multiple steroid injections will also cause varying degrees of irreversible wastage and skin discolouration. Some practitioners may offer multiple steroid injections because they think this approach is the only viable option other than open surgery. This is simply not the case, and patients are much better off moving onto one of the other treatment options that we offer, which have less risk of complication.
Alcohol injections have provided benefit in some cases, evidenced by a limited number of studies. However, the injections are relatively painful and the alcohol cannot be kept local to the nerve, which increases the risk of adverse reactions to the adjacent tissue. We believe that alcohol injections should be avoided because of the risks of complication and our opinion is that the treatment simply isn't specific enough.
Phenol injections are rarely performed for the condition as phenol will cause damage to adjacent tissues, including local blood vessels. We do not advocate this form of treatment because of the risk of complication. Studies have shown the technique to be effective in some cases (Magnan et al 2010).
Some early studies show that botulinum injections can have a positive effect on Morton’s neuroma symptoms. However, we do not currently recommend this approach due a lack of evidence. Botulinum has a temporary effect and patients are likely to require repeat injections.
We use hydro-dissection in specific circumstances, usually after previous surgery. This relatively low-risk procedure involves using higher volumes of fluid (usually an anaesthetic) to treat scar tissue. It can be effective, as evidenced by the positive results we have had at the Centre. The accurate "flushing" of anaesthetic around the nerve can cause the release of adhesions and therefore reduce pain.