Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton’s neuroma



Understanding the risk factors that predict the prognosis of Morton’s neuroma after corticosteroid injection would help clinicians determine the appropriate treatment protocol. However, the cut-off values for the risk factors are unknown. The aim of this study was to identify the risk factors and cut-off values that predict failure of corticosteroid injection in treatment of Morton’s neuroma.


Among 201 patients who had corticosteroid injection for Morton’s neuroma, 40 underwent further treatment after injections. Injection was performed with ultrasound guidance following ultrasound confirmation of the diagnosis. We compared demographic information, size of the neuroma, and other comorbidities between the patients who did and did not undergo further treatment after injection in order to determine the risk factors of failure. Receiver operating characteristic (ROC) curves were constructed to determine optimal cutoff values for each risk factor.


Stepwise logistic regression analysis showed that larger neuromas (p < 0.001) and younger patients (p = 0.026) predicted the failure of corticosteroid injection. The optimal cutoff value for the size of the neuroma was 6.3 mm (sensitivity, 81%; specificity, 95%; positive predictive value, 84%; negative predictive value, 88%) for predicting the failure of corticosteroid injection. Age was not associated with a specific cutoff value.


This study found that, with a cut-off value of 6.3 mm, larger Morton’s neuromas were associated with failure of corticosteroid injection.

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  1. 1.

    Morton TG (1979) The classic. A peculiar and painful affection of the fourth metatarso-phalangeal articulation. Clin Orthop Relat Res 142:4-9

  2. 2.

    Morscher E, Ulrich J, Dick W (2000) Morton’s intermetatarsal neuroma: morphology and histological substrate. Foot Ankle Int 21:558–562

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Levitsky KA, Alman BA, Jevsevar DS, Morehead J (1993) Digital nerves of the foot: anatomic variations and implications regarding the pathogenesis of interdigital neuroma. Foot Ankle 14:208–214

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Jones JR, Klenerman L (1984) A study of the communicating branch between the medial and lateral plantar nerves. Foot Ankle 4:313–315

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Giannini S, Bacchini P, Ceccarelli F, Vannini F (2004) Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot Ankle Int 25:79–84

    Article  PubMed  Google Scholar 

  6. 6.

    Saygi B, Yildirim Y, Saygi EK, Kara H, Esemenli T (2005) Morton neuroma: comparative results of two conservative methods. Foot Ankle Int 26:556–559

    Article  PubMed  Google Scholar 

  7. 7.

    Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D, Yeo ST, Russell IT, Gibson JN (2013) Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am 95(790–798):S791

    Google Scholar 

  8. 8.

    Read JW, Noakes JB, Kerr D, Crichton KJ, Slater HK, Bonar F (1999) Morton’s metatarsalgia: sonographic findings and correlated histopathology. Foot Ankle Int 20:153–161

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J (2016) What factors predict the need for further intervention following corticosteroid injection of Morton’s neuroma? Foot Ankle Surg 22:9–11

    Article  PubMed  Google Scholar 

  10. 10.

    Bennett GL, Graham CE, Mauldin DM (1995) Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int 16:760–763

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Rasmussen MR, Kitaoka HB, Patzer GL (1996) Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res 326:188–193

  12. 12.

    Mahadevan D, Attwal M, Bhatt R, Bhatia M (2016) Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J 98-B:498–503

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Makki D, Haddad BZ, Mahmood Z, Shahid MS, Pathak S, Garnham I (2012) Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot Ankle Int 33:722–726

    Article  PubMed  Google Scholar 

  14. 14.

    Markovic M, Crichton K, Read JW, Lam P, Slater HK (2008) Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton’s neuroma. Foot Ankle Int 29:483–487

    Article  PubMed  Google Scholar 

  15. 15.

    Johnson JE, Johnson KA, Unni KK (1988) Persistent pain after excision of an interdigital neuroma. Results of reoperation. J Bone Joint Surg Am 70:651–657

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Zanetti M, Strehle JK, Zollinger H, Hodler J (1997) Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology 203:516–520

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Biasca N, Zanetti M, Zollinger H (1999) Outcomes after partial neurectomy of Morton’s neuroma related to preoperative case histories, clinical findings, and findings on magnetic resonance imaging scans. Foot Ankle Int 20:568–575

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Zanetti M, Ledermann T, Zollinger H, Hodler J (1997) Efficacy of MR imaging in patients suspected of having Morton’s neuroma. AJR Am J Roentgenol 168:529–532

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Redd RA, Peters VJ, Emery SF, Branch HM, Rifkin MD (1989) Morton neuroma: sonographic evaluation. Radiology 171:415–417

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E (2000) Morton’s neuroma: is it always symptomatic? AJR Am J Roentgenol 175:649–653

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Mann RA, Reynolds JC (1983) Interdigital neuroma—a critical clinical analysis. Foot Ankle 3:238–243

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Hauser ED (1971) Interdigital neuroma of the foot. Surg Gynecol Obstet 133:265–267

    CAS  PubMed  Google Scholar 

  24. 24.

    Lee KT, Lee YK, Young KW, Kim HJ, Park SY (2009) Results of operative treatment of double Morton’s neuroma in the same foot. J Orthop Sci 14:574–578

    Article  PubMed  Google Scholar 

  25. 25.

    Benedetti RS, Baxter DE, Davis PF (1996) Clinical results of simultaneous adjacent interdigital neurectomy in the foot. Foot Ankle Int 17:264–268

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Sharp RJ, Wade CM, Hennessy MS, Saxby TS (2003) The role of MRI and ultrasound imaging in Morton’s neuroma and the effect of size of lesion on symptoms. J Bone Joint Surg Br 85:999–1005

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT (2000) Sonography of Morton’s neuromas. AJR Am J Roentgenol 174:1723–1728

    CAS  Article  PubMed  Google Scholar 

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Author information




Young Hwan Park: Designed the study, Lead investigator and first author.

Ja Woon Lee: Study implementation, Data analysis and interpretation.

Gi Won Choi: Study implementation, Data analysis and interpretation.

Hak Jun Kim: Designed the study, Corresponding author, Primary surgeon, Approval of the final manuscript.

This study was approved by the institutional review board of our institution.


This study was performed in two institutions (Korea University Guro & Ansan Hospital).

Corresponding author

Correspondence to Hak Jun Kim.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the contents of this study.

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Park, Y.H., Lee, J.W., Choi, G.W. et al. Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton’s neuroma. International Orthopaedics (SICOT) 42, 323–329 (2018). https://doi.org/10.1007/s00264-017-3707-8

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  • Morton’s neuroma
  • Corticosteroid injection
  • Risk factors
  • Cutoff values