steroid injections

Corona virus and steroid injections for Morton’s neuroma treatment.

Steroid Injections

Steroid injections are a relatively common treatment for Morton’s neuroma. However, in light of the current Covid-19 crisis we would not recommend anyone having a steroid injection for a Morton’s neuroma, or for that matter, any other musculosketal conditions, such as heel pain or tennis elbow etc. This is because steroid injections, as well as being powerful anti-inflammatory agents are also immunosuppressants, i.e. they reduce the body’s ability to fight off infection. During the flu season prior to giving a steroid injection clinicians screen patients for the presence of chest infections or signs of flu. This is because flu or a chest infection could advance to pneumonia if the immune system is weakened by a steroid injection.

One of the most commonly used steroid injections in the UK for the treatment of Morton’s neuroma is a steroid called methylprednisolone. Methylprednisolone is used elsewhere in medicine to help treat certain types of autoimmune disease. Autoimmune diseases are conditions where the body attacks it's own cells. Examples of autoimmune disease include systemic lupus erythematosus and rheumatoid arthritis. Couples undergoing IVF treatment might also be familiar with methylprednisolone too, as it is often used at the time of embryo implantation, because it helps prevent the mother’s body rejecting the implanted embryo. 

From a lung perspective it is used to treat bronchitis because it dampens down acute inflammation. However, French doctors dealing with Covid-19 have raised concerns about the immunosuppressive effects of steroid injections, as they can in some circumstances cause a delayed healing of lung tissue affected by the Covid-19 virus. There is some speculation that specialist white blood cells called macrophages, which help remove damaged tissue and, are suppressed by steroids. 

For the time being it might be prudent for those with underlying heath problems such as heart or respiratory disease to give steroid injections for Morton’s neuroma a miss. In any event, there is debate about whether or not steroid injections provide any long-term help for neuromas and when they do help, by what mechanism they are providing the relief. The current research suggests that the diameter of the neuroma is quite important. If the diameter of the neuroma exceeds 5.5 mm then the likelihood of gaining any benefit, or the benefit lasting more than a few months is slim. 

Some experts question the ‘anti-inflammatory effect’ of the steroid injection on the neuroma. Some argue that the benefits of the steroid injection are not directly related to the anti-inflammatory effects, but more to the shrinkage of surrounding muscle tissue. Steroid injections are known to cause atrophy or shrinkage of tissue, some think that rather than causing the neuroma to shrink the small lumbrical muscles that surround the neuroma shrink instead, thereby decompressing the neuroma, and giving some tempory relief. However, when the muscles recover to their normal size the neuroma becomes compressed again, generating pain.

The benefits of cryosurgery include:

  • It can be performed without the use of steroid.
  • That the enlarged nerve or neuroma after cryosurgery will return to a normal diameter of 1-2 mm.
  • When the nerve has returned to normal, (typically after 3 months after cryosurgery) there is normally no loss of sensation, and no residual pain.
  • Cryosurgery for Morton's neuroma has an excellent safety record.

If you have recently had a steroid injection should you be worried?

Most definitely not, overall the risk is likely to very small and the data on this issue is still very scant and emerging.  It is worth remembering the worst affected people are people whose immune systems go into ‘overdrive’ and generally methylprednisolone is used for dampening down such reactions. Furthermore, the effects of steroid injections are fairly short lived.

So at the moment we are treating steroid injections as an 'unknown' factor and erring on the side of caution.

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