Morton’s Neuroma Treatment Surgery Michigan 2026

Treatment	Mechanism	Success Rate	Duration	Best For
Footwear Modification + Metatarsal Pad	Wide toe box reduces intermetatarsal compression; pad redistributes pressure proximal to neuroma	30–40% significant relief	Long-term daily use	First-line; mild-moderate symptoms; all patients before injection
Corticosteroid Injection (ultrasound-guided)	Reduces perineural inflammation and edema; temporary relief	50–70% at 1 year; relief fades in most	1–3 injections; 6-week intervals	Moderate symptoms; failed footwear; avoid in diabetics
Alcohol Sclerosing Injection Series	4% alcohol sclerosing agent; progressive neural fibrosis	60–80% at 6–12 months; permanent in responders	3–7 injections; weekly or biweekly	Permanent non-surgical option; failed steroid injections
Cryotherapy (cryo-ablation)	Freeze-thaw cycle destroys nerve function while preserving sheath (neurotmesis without neuroma)	65–80% at 12 months	Single session; may repeat	Alternative to surgery; avoids permanent resection complications
Surgical Excision (neurectomy)	Surgical removal of enlarged interdigital nerve; dorsal or plantar approach	80–90% pain relief	4–6 weeks recovery	Failed conservative care × 3–6 months; large neuroma (>5mm on ultrasound)

Space	Most Common?	Symptoms	Ultrasound Size (symptomatic threshold)	Notes
3rd Web Space (3rd–4th MTP)	Most common (70–80% of neuromas)	Burning, numbness, tingling 3rd–4th toes; Mulder’s click	≥5mm diameter on US	Common peroneal digital nerve; most amenable to surgery
2nd Web Space (2nd–3rd MTP)	Second most common (15–20%)	Similar burning in 2nd–3rd toe cleft; may coexist with 3rd space	≥5mm	Often concurrent with metatarsalgia; consider Weil osteotomy if MT pathology
1st or 4th Web Space	Rare (<5%)	Atypical presentation; consider other diagnoses	Variable	Confirm with MRI if ultrasound equivocal; exclude metatarsalgia, stress fracture
Bilateral / Multiple	Uncommon — check for systemic cause	Symmetric bilateral burning forefoot	Variable	Rule out: diabetic neuropathy, B12 deficiency, Charcot-Marie-Tooth

https://www.youtube.com/watch?v=MAFjGzjQv6w

The burning, electric, shooting pain between your toes that feels like you’re walking on a marble or a bunched-up sock? That’s Morton’s neuroma — a perineural fibrosis (scarring around the nerve) of the common digital nerve, most often in the 3rd interspace (between 3rd and 4th toes). At Balance Foot & Ankle PLLC, Dr. Tom Biernacki provides accurate ultrasound-assisted diagnosis and a full spectrum of treatment from conservative to surgical.

Diagnosis

Clinical examination: Mulder’s click (squeezing the metatarsals produces an audible or palpable click), direct point tenderness in the interspace, burning pain radiating to the toes. MRI identifies neuromas greater than 5mm with good sensitivity. Ultrasound — in skilled hands — is highly accurate, cost-effective, and allows real-time visualization during guided injection. Dr. Biernacki uses ultrasound guidance for all neuroma injections.

Treatment Protocol

Conservative Phase: Wide toe-box footwear (critical — narrow shoes are the primary aggravating factor), metatarsal pad placement proximal to the neuroma, custom orthotics with metatarsal dome, and anti-inflammatory medication. Many patients achieve significant relief from footwear modification alone. Injection Therapy: Ultrasound-guided corticosteroid injection into the interspace — 60–70% response rate. Maximum 2–3 injections (fat pad atrophy and plantar fascia weakening risk with overuse). Alcohol Sclerotherapy Series: 4% alcohol solution injected under ultrasound guidance in a series of 4–7 injections. 70–85% success rate in carefully selected patients — excellent alternative to surgery for refractory neuromas. Surgical Excision: Dorsal approach neuroma excision through a small intermetatarsal incision. 80–90% success rate. Post-operative numbness in the affected toe web space is expected and permanent.

Recurrent Neuroma

Recurrent neuroma after surgical excision — a stump neuroma — is painful and challenging to treat. Dr. Biernacki performs revision excision with implantation of the nerve stump into the adjacent muscle belly to prevent re-neuroma formation. This is specialized surgery requiring careful planning.

Dr. Tom's Product Recommendations

Frequently Asked Questions

How long does treatment take to work?

Most patients see improvement in 4-8 weeks with consistent conservative care. Persistent symptoms after 8 weeks need imaging and escalation.

When is surgery needed?

Surgery is reserved for cases that fail 3-6 months of conservative care, structural deformities, or fractures requiring stabilization.

Is this covered by insurance?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Custom orthotics often require diabetic or post-surgical justification.

Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Township. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.