Neuroma
Conservative Treatment
CORTISONE INJECTION
Rationale of this Treatment
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Once the diagnosis has been established and confirmed with either ultrasound or MRI scan the decision to treat is based on the degree of pain. In the absence of any pain or discomfort there is no need to treat this condition.
Treatment should follow a logical path and the lowest risk, least invasive treatments are recommended before surgery.
Please note that despite widespread use there is no evidence to support the use of insoles or orthotics to treat neuromas
A sensible treatment plan is shown in the diagram here. Cortisone injections are a useful initial treatment as they can relieve the pain of the neuroma in about 50-60% of patients without the need for an operation. Although the injection may not provide a cure indefinitely many people have relief of pain for many months.
Cortisone injections work because they have an “anti-inflammatory” action on the damaged nerve. They are often combined with a local anaesthetic. The benefit from the injection often takes two to three weeks to develop. Immediately afterwards the area will be numb due to the local anaesthetic.
Effectiveness of this Treatment
This treatment will provide a significant amount of pain relief in just over half of patients. It is more effective if the neuroma is small. The injection may in some cases provide a complete cure but is more usual for the injection to last 6-18 months.
Advantages of this Treatment
The treatment has few complications and is therefore safer than an operation. The injection can be given without the need to go into hospital.
Disadvantages of this Treatment
Like all treatments they are only as good as the person providing them. These injections require the consultant to place the needle time very close to the damaged nerve. These injections should only be given by those experienced in this technique. Sometimes the foot can be more painful for a day or so once the local anaesthetic wears off. Other complications are possible.
Duration of this Treatment
We would recommend you see your consultant for a review appointment eight weeks after the initial injection. If there has been some improvement it is possible to repeat the injections. We would not normally recommend repeating the injections more than three times per year. Each patient is different and the consultant will advise you as to the best options for you.
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