Conservative and surgical treatments for Morton's neuroma: a systematic review of pain relief and recurrence

Introduction: Morton's neuroma is a compressive neuropathy of the interdigital nerve for which conservative and surgical options coexist without consensus on which treatment achieves the best pain relief and the lowest recurrence. Methods: Scopus, PubMed, OpenAlex and Crossref were searched for studies published between 2016 and 2025 reporting pain, function, recurrence or complications after treatment of Morton's neuroma. Selection followed PRISMA 2020. Risk of bias was assessed with RoB 2 and the Newcastle-Ottawa Scale. Results: From 800 records, 47 studies were included: 8 randomized trials and 38 observational studies. Reported success rates in 20 single-arm series ranged from 59.10% to 95%. High risk of bias predominated (39 of 47 studies). Corticosteroid injections produced short-term relief but up to half of patients required further injection or surgery, and ultrasound-guided injection outperformed blind injection in two trials. Sclerosing injections and radiofrequency ablation achieved satisfaction between 82% and 92.5%. Neurectomy yielded good or excellent results in 74% to 94% of feet, whereas decompression without resection carried the highest recurrence (47.5%). Conclusions: No single treatment was clearly superior; the choice depends on neuroma size, symptom duration and patient preference. Confidence is limited by predominantly retrospective, high risk of bias designs.