Treatment of Morton’s neuroma: the evidence

Abstract

Morton's neuroma is a common injury of the forefoot that affects the third web space of the toes. The pain, localized to the forefoot and toes, may appear gradually but usually becomes significant and persistent. Often it occurs after walking and is relieved by removing the shoe and manipulating the forefoot. The management of this condition varies widely and includes conservative and surgical treatments. There is no general agreement on the optimal treatment for this pathology. The aim of this review was to collect and assess the scientific evidence reported in the literature supporting the different treatments in the management of Morton's neuroma, comparing the different outcomes of conservative and surgical treatments. A literature analysis was performed on the different managements in the search for the best scientific evidence on this topic.

Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

“…Currently, as many as 70% of those with PDN receive surgical intervention prior to any conservative treatment at all other than a corticosteroid injection 5 the value of which has been questioned in relation to PDN. 18,27 Rasmussen reports that 20% of patients experienced no benefit at all from a steroid injection, with a further 54% experiencing a benefit which lasted for less than three months. 27 A later study demonstrated that 41% of patients were dissatisfied with the outcome of steroid injection therapy in relation to PDN.…”

“…11,17 Despite the range of advocated interventions, there is little agreement among clinicians as to the best treatment protocol for PDN. 18 It remains a difficult condition to resolve and is often a limiting factor in the individuals leisure pursuits and work life. 5,19 There is as yet very little empirical evidence that supports the use of one therapy over another and, despite surgery being generally accepted as the gold standard treatment, there is to date no evidence that it results in better patient outcomes than conservative care.…”