Ultrasound-Guided Cortisone Injections for Morton’s Neuroma

 Introduction

Morton’s Neuroma is a painful condition affecting the foot, often described as a burning or sharp sensation between the toes. It results from the thickening of nerve tissue, typically between the third and fourth toes, and can significantly impact mobility and quality of life. At Alton Pain Clinic, we specialise in precise, minimally invasive treatments, such as ultrasound-guided cortisone injections, designed to provide targeted relief for this condition. This blog explores the anatomy, pathology, and management of Morton’s Neuroma, with a focus on the benefits of cortisone injections tailored to your needs.

Anatomy of the Foot and Nerves
The foot comprises multiple bones, muscles, ligaments, and nerves that work together to provide stability and mobility.

• Metatarsals: Five long bones in the forefoot connecting to the toes.
• Intermetatarsal Spaces: Spaces between the metatarsals where nerves and blood vessels run.
• Plantar Digital Nerves: Branches of the tibial nerve that provide sensation to the toes. These nerves pass through the intermetatarsal spaces, making them vulnerable to compression.
• Transverse Metatarsal Ligament: A structure that stabilises the forefoot and often compresses the nerve in cases of Morton’s Neuroma.

Pathology of Morton’s Neuroma
Morton’s Neuroma occurs due to the thickening of the plantar digital nerve, often resulting from chronic irritation, compression, or trauma. This leads to fibrosis around the nerve, causing pain and discomfort.

Key contributing factors include:

• Biomechanical Abnormalities: Excessive pressure on the forefoot due to flat feet, high arches, or improper gait.
• Inappropriate Footwear: Tight or high-heeled shoes that squeeze the toes.
• Repetitive Trauma: Activities such as running or sports that place stress on the forefoot.
• Inflammation: Swelling in the intermetatarsal space can exacerbate nerve compression.

Symptoms of Morton’s Neuroma
The symptoms of Morton’s Neuroma vary in intensity and may include:

• Sharp or burning pain between the toes, often aggravated by walking or wearing shoes.
• Tingling or numbness in the affected toes.
• A sensation of having a pebble or lump in the shoe.
• Pain relief when removing shoes or massaging the foot.

Diagnosis
Accurate diagnosis is crucial for effective treatment. At Alton Pain Clinic, we use a combination of clinical evaluation and advanced imaging techniques:

1. Physical Examination:

• Assessing tenderness in the intermetatarsal spaces.
• Compression tests to reproduce symptoms.

2. Ultrasound Imaging:

• Provides real-time visualisation of the thickened nerve and surrounding structures.
• Ensures precise localisation of the affected area.

Management of Morton’s Neuroma
Management approaches depend on the severity of the condition:

Conservative Treatments:

• Footwear Modifications: Switching to wide, cushioned shoes to reduce pressure.
• Orthotic Devices: Custom insoles to support the foot and relieve nerve compression.
• Physical Therapy: Exercises to improve foot biomechanics.
• Interventional Treatments:
• For persistent or severe cases, ultrasound-guided cortisone injections offer a targeted solution.

Ultrasound-Guided Cortisone Injections
Cortisone injections are a minimally invasive treatment that helps reduce inflammation and alleviate pain associated with Morton’s Neuroma. At Alton Pain Clinic, these injections are performed using advanced ultrasound guidance to ensure precision.

Mechanism of Action
Cortisone works by:

1. Reducing Inflammation:

• Suppresses the release of pro-inflammatory mediators such as prostaglandins and cytokines.
• Decreases swelling in the intermetatarsal space, reducing nerve compression.

2. Relieving Pain:

• Cortisone lowers pressure on the nerve, alleviating discomfort and improving mobility.

3. Facilitating Recovery:

• By addressing inflammation, cortisone creates an environment conducive to healing and symptom relief.

Benefits of Ultrasound Guidance
Ultrasound guidance enhances the accuracy and safety of cortisone injections. Benefits include:

• Real-time visualisation of the affected nerve and surrounding structures.
• Precise delivery of medication to the inflamed area.
• Minimised risk of complications, such as injection into adjacent tissues.
• Improved patient comfort during the procedure.

Why Choose Alton Pain Clinic?
At Alton Pain Clinic, we are dedicated to providing tailored care for each patient. Our expertise in ultrasound-guided procedures ensures precise and effective treatment, helping you achieve relief from Morton’s Neuroma with minimal downtime. With a focus on patient-centred care, we aim to support your journey to improved mobility and comfort.

When to Consider Cortisone Injections
Ultrasound-guided cortisone injections may be appropriate for individuals who:

• Experience persistent pain despite conservative measures.
• Require a minimally invasive option before considering surgery.
• Have significant inflammation impeding recovery.

Post-Injection Care
Following a cortisone injection, patients should:

• Rest the foot for 24–48 hours to optimise recovery.
• Gradually resume activities as advised by their clinician.
• Wear supportive footwear to prevent further irritation.

Conclusion
Morton’s Neuroma can be a debilitating condition, but effective treatments are available. Ultrasound-guided cortisone injections provide a precise and minimally invasive option to reduce inflammation and relieve pain. At Alton Pain Clinic, we prioritise tailored care, ensuring each patient receives the most appropriate treatment for their needs. If you are struggling with foot pain or suspect Morton’s Neuroma, consider consulting our experienced team for expert evaluation and management.