What are the treatment options for interdigital neuritis?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

If interdigital neuritis (also referred to as Morton neuroma, Morton metatarsalgia, interdigital neuroma, or interdigital nerve compression) is detected early, conservative measures may be reasonably successful. About 20-30% of patients achieve adequate relief with nonoperative management. This may be accomplished by eliminating or minimizing the external sources of compression or stretch on the interdigital nerve.

Extra-wide shoes and low heels, as well as the placement of a small metatarsal pad just proximal to the heads of the central three metatarsals, may reduce symptoms by increasing the intermetatarsal space, elevating the metatarsals and the intermetatarsal ligament, and reducing the likelihood of neural irritation. Accommodative orthotic devices with built-in metatarsal pads may at times be helpful, especially in patients with alignment abnormalities. Stiffer, rocker-soled shoes may be useful.

NSAIDs may relieve acute pain and inflammation. If NSAIDs provide insufficient relief, a local anesthetic injection can also relieve pain and may help to confirm the diagnosis of interdigital neuritis.

Mann et al did not find corticosteroid injections to result in predictable or lasting relief. [50] Rasmussen et al reported initial pain relief in 80% of patients who received a single corticosteroid injection [51] ; however, 47% of the 41 feet studied ultimately required surgical excision, and most of the remaining 53% had residual symptoms.

In addition, corticosteroid injection for intermetatarsal neuroma has been associated with a number of complications, including plantar fat-pad atrophy, skin depigmentation, hyperpigmentation, and telangiectasias. Fat-pad atrophy can result in metatarsalgia and gait impairment.


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