Orthotics and corticosteroid injections are widely used conservative treatments for<unk> . In addition to traditional orthotic arch supports, a small foam or fabric pad may be positioned under the space between the two affected metatarsals, immediately behind the bone ends. This pad helps to splay the metatarsal bones and create more space for the nerve so as to relieve pressure and irritation. However, it may also elicit mild uncomfortable sensations of its own, such as the feeling of having an awkward object under one's foot. Toe spreaders are another form of conservative orthotic treatment that may yield relief for<unk>  symptoms. Corticosteroid injections can relieve inflammation in some patients and help end the symptoms. For some patients, however, the inflammation and pain recur after some weeks or months, and corticosteroids may only be used a limited number of times because they cause progressive degeneration of ligamentous and tendinous tissues. Sclerosing alcohol injections are an increasingly available treatment alternative if other management approaches fail. Dilute alcohol (4%) is injected directly into the area of the<unk> , causing toxicity to the fibrous nerve tissue. Frequently, treatment must be performed two to four times, with one to three weeks between interventions. A 60–80% success rate has been achieved in clinical studies, equal to or exceeding the success rate for surgical neurectomy, with fewer risks and less significant recovery. If done with more concentrated alcohol under ultrasound guidance, the success rate is considerably higher and fewer repeat procedures are needed. Radiofrequency ablation is also used in the treatment of<unk> . The outcomes appear to be similar to, or even more reliable than, alcohol injections, especially if the procedure is performed under ultrasound guidance. A 2019 systematic review of randomised controlled trials found that corticosteroid injections or manipulation/mobilisation reduced pain more than control, extracorporeal shockwave therapy or varus/valgus foot wedges (which did not reduce pain more than control or comparison treatment, and pain reduction was not reported in any wider foot/metatarsal padding studies). The review also found no randomised controlled trials for sclerosing alcohol injections, radiofrequency ablations, cryoneurolysis or botulinum toxin injections. These treatments have only been assessed with pre-test/post-test case series, which do not measure the benefit of treatment beyond any placebo effect, sham treatment or any natural improvement over time. If such interventions fail, patients are commonly offered neurectomy, a surgery that involves removing the affected piece of nerve tissue. Postoperative scar tissue formation (known as stump<unk>  can occur in approximately 20–30% of cases, causing a return of<unk>  symptoms. Neurectomy may be performed using one of two general methods. Making the incision from the dorsal side (the top of the foot) is the more common method but requires cutting the deep transverse metatarsal ligament that connects the third and fourth metatarsals in order to access the nerve beneath it. This results in exaggerated postoperative splaying of the third and fourth digits (toes) resulting from the loss of the supporting ligamentous structure. This has aesthetic concerns for some patients and possible, though unquantified, long-term implications for foot structure and health. Alternatively, making the incision from the ventral side (the sole of the foot) allows more direct access to the affected nerve without cutting other structures. However, this approach requires a greater post-operative recovery time in which the patient must avoid weight-bearing on the affected foot, because the ventral aspect of the foot is more highly enervated and impacted by pressure when standing. It also carries an increased risk of scar-tissue formation in a location that causes ongoing pain. Cryogenic<unk> blation (also known as cryoinjection therapy, cryoneurolysis, cryosurgery or cryoablation) is a lesser-known alternative to neurectomy surgery. It involves the destruction of axons to prevent them from carrying painful impulses. This is accomplished by making a small incision (~3 mm) and inserting a cryoneedle that applies extremely low temperatures of between −50 °C to −70 °C to the nerve/neuroma, resulting in degeneration of the intracellular elements, axons and myelin sheath (which houses the<unk>  with wallerian degeneration. The epineurium and perineurium remain intact, thus preventing the formation of stump<unk> . The preservation of these structures differentiates cryogenic<unk> blation from surgical excision and neurolytic agents such as alcohol. An initial study showed that cryoneuroablation is initially equal in effectiveness to surgery but does not have the risk of stump<unk>  formation. An increasing range of procedures are being performed at specialist centers to treat<unk>  under ultrasound guidance. Recent studies have shown excellent results for the treatment of the condition with ultrasound-guided sclerosing alcohol injections, radiofrequency ablation and cryoablation.
Morton's neuroma
Bunion
Traumatic neuroma
Plantar fibromatosis
Volkmann's contracture
Dupuytren's contracture
Heel pad syndrome
Median rhomboid glossitis