II. Indications

  1. Morton's Neuroma refractory to other measures

III. Preparation

  1. Needle
    1. Gauge: 25 to 27
    2. Length: 1.0 to 1.5 inches
  2. Syringe: 3 to 5 ml
  3. Corticosteroid options
    1. Betamethasone (Celestone) 0.5 ml of 6 mg/ml
    2. Methylprednisolone (Solu-medrol): 0.5 ml of 40 mg/ml
  4. Anesthetic
    1. Lidocaine 1%: 1 to 2 ml or
    2. Bupivacaine 0.25% or 0.5%: 1 to 2 ml

IV. Technique

  1. Patient position
    1. Supine position with knee flexed over towel roll
    2. Foot in neutral position
  2. Landmarks
    1. Interdigital space between Metatarsal heads
    2. Mark area maximal tenderness
  3. Sterilize local skin with betadine or hibiclens
  4. Insert needle into skin at point of maximal tenderness
    1. Angle needle 45 degrees proximally toward heel
    2. Do not inject into plantar fat pad
  5. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion

V. Adverse Effects

  1. Plantar fat pad atrophy

VI. Follow-up Instructions

  1. No stress to foot for 2 weeks after injection
  2. Examine again in 3 weeks post-injection

VII. References

  1. Greene (2001) Musculoskeletal Care, AAOS, p. 480-1
  2. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]

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