Morton’s Neuroma Injection: Cortisone, Alcohol, and What to Expect

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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Injections for Morton’s Neuroma: An Overview

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When Morton’s neuroma doesn’t respond to footwear modifications and metatarsal padding, injection therapy is the next step before considering surgery. Multiple injection types are available—corticosteroid (cortisone), alcohol sclerosing, and newer modalities like radiofrequency ablation. Each has a different mechanism, success rate, and role in the treatment progression. Understanding the options helps patients make informed decisions about their care in collaboration with their podiatrist.

Corticosteroid (Cortisone) Injection

Corticosteroid injection is the first-line injection treatment for Morton’s neuroma, providing potent anti-inflammatory effect that reduces the perineural inflammation and swelling that contributes to pain. The injection delivers a combination of local anesthetic (for immediate pain relief) and corticosteroid (for sustained anti-inflammatory effect) into the intermetatarsal space adjacent to the neuroma. The procedure is performed in the office without sedation and takes approximately 2–3 minutes; patients typically experience immediate numbness from the anesthetic followed by return of mild discomfort for 24–48 hours as the anesthetic wears off before the corticosteroid takes full effect (3–7 days).

Success rates for corticosteroid injection in Morton’s neuroma are approximately 50–70% for meaningful pain reduction with a single injection. Multiple injections (typically a series of 2–3, spaced 4–6 weeks apart) improve success rates. Repeated corticosteroid injections carry risks of plantar fat pad atrophy, skin depigmentation, and weakening of adjacent tendons and ligaments—limiting the total number of injections appropriate at any single site to 3–4 lifetime.

Alcohol Sclerosing Injections

Alcohol sclerosing injection therapy uses dilute alcohol (4% concentration) to cause progressive fibrosis and destruction of the nerve tissue—essentially permanently reducing the neuroma’s signaling capacity without surgery. A series of 4–7 injections spaced 1–2 weeks apart is typical. Ultrasound guidance improves accuracy and outcomes. Published studies report good-to-excellent pain relief in 60–80% of patients completing the full series, with durable results at 2–year follow-up. Alcohol sclerosing therapy offers an alternative to surgery for patients who fail corticosteroid injections, with a lower risk profile than surgical excision (no wound, no recovery period, preserved nerve function if unsuccessful). The primary disadvantage is the number of injections required; some patients find the series burdensome.

Ultrasound-Guided Injection

Ultrasound guidance significantly improves injection accuracy for Morton’s neuroma—the neuroma is visible on ultrasound as a hypoechoic (dark) mass in the intermetatarsal space, allowing the needle to be positioned precisely adjacent to or within the lesion. Studies comparing ultrasound-guided versus unguided injection for Morton’s neuroma consistently show better outcomes with guidance: higher success rates, lower medication doses needed, and fewer side effects from inadvertent injection into adjacent structures. Ultrasound-guided injection is the preferred technique when available.

When Injections Fail: What’s Next?

When corticosteroid and alcohol injection therapy fail to provide adequate relief, surgical excision of the neuroma is the next option. Surgical results are excellent—approximately 85–90% of patients achieve good-to-excellent pain relief with neuroma excision. The neuroma is accessed through either a dorsal (top of foot) or plantar (bottom of foot) incision; the neuroma is identified and removed with sufficient nerve length to allow the remaining nerve end to retract away from the weight-bearing area. Recovery involves 2–3 weeks in a post-operative shoe followed by return to normal footwear. A permanent area of numbness in the web space between the third and fourth toes is expected after excision—most patients find this minor compared to the pre-operative pain.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your Morton’s neuroma, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

Medical References & Sources

• PubMed Research — Morton’s Neuroma Injection Outcomes
• PubMed Research — Alcohol Sclerosing for Morton’s Neuroma
• American Orthopaedic Foot & Ankle Society — Morton’s Neuroma

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He performs ultrasound-guided corticosteroid and alcohol sclerosing injections for Morton’s neuroma, as well as surgical excision when injection therapy is insufficient.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Morton’s Neuroma and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Capsulitis (2nd MTP). Pain at 2nd-toe base rather than between toes; drawer test positive.
• Stress fracture. Single-point tenderness over a metatarsal shaft, not between toes.
• Freiberg’s infraction. AVN of metatarsal head, classic radiograph flattening.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Adding a cushioned insole instead of a metatarsal pad. Fix: place the metatarsal pad PROXIMAL to (behind) the metatarsal heads — not directly under them.

Warning Signs That Need Same-Day Care

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Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)

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Top 10 Premade Orthotics — Dr. Tom’s Picks (2026)

Dr. Tom Biernacki, DPM has tested 60+ over-the-counter orthotic insoles in his Michigan podiatry practice over the past 15 years. Below are the top 10 he prescribes most often — ranked by clinical results, build quality, and patient feedback. PowerStep + CURREX brands are Dr. Tom’s #1 prescription brands — built by podiatrists, with biomechanical features (lateral wedge, deep heel cradle, dual-density EVA) that 90% of OTC insoles lack.

Frequently Asked Questions

What does a Morton’s neuroma feel like?

Patients most often describe it as walking on a pebble or a bunched-up sock — a burning, aching pressure between the third and fourth toes. Some feel an electric shock-like sensation that radiates into the adjacent toes. The pain typically worsens in narrow shoes and improves when barefoot or in wide, low-heeled footwear. This shoe-dependent pattern is the hallmark — if removing your shoes relieves your forefoot pain within minutes, a neuroma is the most likely diagnosis.

What causes a Morton’s neuroma?

A neuroma forms when the digital nerve running between the metatarsals becomes compressed and irritated, leading to perineural fibrosis (scar tissue thickening around the nerve). Common causes: narrow footwear that compresses the forefoot, high heels that shift body weight to the metatarsals, foot deformities (bunions, hammer toes, flat feet) that alter metatarsal spacing, and high-impact repetitive activity. Women develop neuromas 8–10 times more often than men, largely due to footwear choices.

Can a Morton’s neuroma go away without treatment?

Mild neuromas occasionally resolve with footwear changes alone — switching to wide, low-heeled shoes removes the compression causing symptoms. However, once a neuroma has been symptomatic for 6+ months, the nerve thickening is usually permanent without active intervention. Conservative treatment (footwear, metatarsal pads, steroid injections) resolves symptoms in 50–70% of patients. Surgery (neurectomy) has a 75–85% success rate for cases that don’t respond to conservative care.

Does a Morton’s neuroma require surgery?

Only when conservative options have failed. The escalation: wide-toe-box shoes + metatarsal pads → corticosteroid injection (works in 40–60%) → ultrasound-guided alcohol sclerosing injections (70–80% success) → surgical neurectomy. Surgery involves removing the thickened nerve segment under local anesthesia with a short recovery (2–4 weeks). The trade-off: permanent numbness in the web space between the affected toes. Most patients consider this acceptable given significant pain resolution.

How is a Morton’s neuroma diagnosed?

Clinical diagnosis is most common — the history and Mulder’s test (side-to-side metatarsal compression that recreates pain or a palpable click) identify the majority of cases. Ultrasound confirms the diagnosis and measures neuroma size — this helps predict treatment response; small neuromas (<5mm) respond well to injections, large ones (>8mm) often need surgery. MRI is reserved for atypical cases where a ganglion cyst, bursitis, or stress fracture may be mimicking a neuroma.

Can I run with a Morton’s neuroma?

Often yes, with the right footwear. Switching to wide-toe-box running shoes (Altra, Hoka with wide forefoot) with a metatarsal pad placed just proximal to the 3rd–4th interspace reduces compression during running. Reduce mileage temporarily. If pain exceeds 4/10 during a run, the nerve is being compressed and stop — continuing through moderate pain causes further fibrosis. Most runners with neuromas can return to full training after 4–8 weeks of proper shoe and pad adjustment.

Can both feet have neuromas at the same time?

Yes — bilateral neuromas occur in about 15–20% of neuroma patients, most commonly in women with a history of prolonged narrow-shoe wear. Multiple neuromas in the same foot (double neuroma) are less common but occur. When both feet are symptomatic, we typically treat the more painful side first to assess response before proceeding to the other foot. The treatment approach is the same bilaterally.

What shoes are best for Morton’s neuroma?

Wide, deep toe box is the top priority — enough room that the metatarsal heads aren’t compressed at all. Low heel (under 1 inch) to minimize forefoot load. Firm, cushioned forefoot. Best performers: Altra Torin, Hoka Bondi (wide toe box version), New Balance 574/993, Brooks Adrenaline wide. The test: you should be able to wiggle all toes freely with the shoe on. If the forefoot feels snug, the shoe is compressing the neuroma.

What is a metatarsal pad and does it help neuromas?

A metatarsal pad placed proximal to (just behind) the 3rd–4th metatarsal heads spreads those metatarsals apart, decompressing the interdigital nerve. It’s one of the most cost-effective interventions — $5–15 for OTC pads, significant relief for 50–60% of patients when placed correctly. Placement is everything: the pad goes behind the metatarsal heads, not under them. We fit them in-office to confirm position. Incorrectly placed pads (under the heads) increase compression and worsen symptoms.

Are corticosteroid injections safe for Morton’s neuroma?

Yes — for short-term pain relief. Ultrasound-guided cortisone injections reduce inflammation and perineural swelling, resolving symptoms in 40–60% of patients for 3–12 months. We limit to 2–3 injections per neuroma; repeated injections can cause fat pad atrophy and skin depigmentation. If 2 injections don’t produce lasting relief, alcohol sclerosing injections (3–5 treatment series, 70–80% success) or surgery is the next step. Injections are office-based, take 5 minutes, and are covered by most insurance plans.

Related Care at Balance Foot & Ankle

Clinical morton services at our Howell and Bloomfield Hills offices.

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