This document addresses the indications for injection treatment of Morton's neuroma, a common paroxysmal neuralgia affecting the web spaces of the toes. 

Clinical Indications

Medically Necessary:

Injections of anesthetic, sclerosing (neurolytic), or steroid agents are considered medically necessary for treatment of Morton’s neuroma when all of the following conservative therapies have failed:

1. Padding or orthotic devices (these can provide support to reduce pressure and compression on the nerve); and
2. Activity modification (to reduce repetitive pressure on the nerve); and
3. Changes in shoe wear (that is, shoes with a wide box toe reduce compression of the metatarsal heads and reduce pressure on the nerve); and
4. Medications unless otherwise contraindicated (for example, nonsteroidal anti-inflammatory drugs which help reduce inflammation).

Not Medically Necessary:

Injection treatment of Morton’s neuroma is considered not medically necessary when the above criteria are not met.