II. Indications
- Morton's Neuroma refractory to other measures
III. Preparation
- Needle
- Gauge: 25 to 27
- Length: 1.0 to 1.5 inches
- Syringe: 3 to 5 ml
-
Corticosteroid options
- Corticosteroid offers no benefit over Anesthetic injection alone (see efficacy below)
- Betamethasone (Celestone) 0.5 ml of 6 mg/ml
- Methylprednisolone (Solu-Medrol): 0.5 ml of 40 mg/ml
- Triamcinolone (Kenalog) 0.5 ml of 40 mg/ml
-
Anesthetic
- Lidocaine 1%: 1 to 2 ml or
- Bupivacaine 0.25% or 0.5%: 1 to 2 ml
- Ropivacaine 0.25 to 0.5% 1 to 2 ml
IV. Technique: Anatomic
- Patient position
- Supine position with knee flexed over towel roll
- Foot in neutral position
- Anatomic Landmarks
- Interdigital space between Metatarsal heads
- Mark area maximal tenderness
-
Ultrasound guidance
- High frequency linear probe positioned in short axis over the dorsal foot at interdigital space
- Inject out of plane
- Sterilize local skin with Betadine or Hibiclens
- Insert needle into skin at point of maximal tenderness
- Needle insertion is into the dorsal foot, between the Metatarsal heads
- Angle needle 45 degrees proximally toward heel
- Do not inject into plantar fat pad
- Avoid injecting deep to the intermetatarsal Muscles (fullness)
- Patient lies supine for several minutes after procedure
- Distribute with passive foot range of motion
V. Efficacy
- Better efficacy under Ultrasound guidance
-
Anesthetic alone is as effective as if combined with coticosteroid
- Anesthetic alone injections also avoids adverse effects (soft tissue atrophy)
- References
VI. Adverse Effects
- Plantar fat pad atrophy
VII. Management: Follow-up Instructions
- No stress to foot for 2 weeks after injection
- Examine again in 3 weeks post-injection
VIII. References
- Greene (2001) Musculoskeletal Care, AAOS, p. 480-1
- Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]
- Wilcox (2026) Am Fam Physician 113(5): 431-9 [PubMed]