What non-surgical management strategies are recommended for patients diagnosed with Morton's neuroma?

Non-surgical management strategies for Morton's neuroma focus on symptom relief and functional improvement. Initial treatment typically includes conservative measures such as footwear modification to reduce forefoot pressure, using shoes with a wide toe box and low heels to alleviate nerve compression. Orthotic devices, including metatarsal pads or custom insoles, are recommended to redistribute pressure away from the affected interdigital nerve. Additionally, activity modification to avoid aggravating movements can help reduce symptoms.

Pharmacological options include the use of non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Local corticosteroid injections around the neuroma are commonly employed to reduce inflammation and provide temporary symptom relief, often considered when conservative measures alone are insufficient. Some evidence supports the use of alcohol sclerosing injections or other neurolytic agents, but these are less established and typically reserved for refractory cases.

Physical therapies such as ultrasound therapy or nerve gliding exercises may be adjunctive but have limited high-quality evidence supporting their efficacy. Overall, non-surgical management aims to control pain and improve function, reserving surgery for patients who do not respond to these interventions.

This integrated approach aligns with UK clinical guidelines emphasizing conservative care as first-line management, supported by systematic reviews indicating that injection therapies can improve pain and patient satisfaction but are not definitive cures (Jain and Mannan, 2013; Lu et al., 2021) ¹.