Radiofrequency Ablation (RFA) for Morton’s Neuroma
What is Morton’s neuroma?
Morton’s neuroma is a painful condition affecting a small nerve between the toes, most commonly between the third and fourth toes. The nerve becomes thickened and irritated, which can cause:
- Burning or sharp pain in the forefoot
- Tingling or numbness in the toes
- A sensation of standing on a pebble or a fold in a sock
What is radiofrequency ablation (RFA)?
Radiofrequency ablation is a minimally invasive procedure that uses controlled heat energy to reduce pain signals from the affected nerve. A thin needle is placed into the neuroma using ultrasound guidance, and radiofrequency energy is then delivered to treat the nerve tissue. The aim is to reduce pain while avoiding open surgery.
Why am I being offered RFA?
RFA is usually considered if:
- Symptoms have persisted despite footwear changes or orthotics
- Injection treatments have not given lasting relief
- Surgery is not currently required, or you wish to avoid surgery
RFA does not remove the neuroma, but aims to reduce pain by treating the affected nerve.
How successful is RFA?
Most patients experience meaningful pain improvement.
- In a recent published study, around three-quarters of patients treated with RFA avoided the need for open surgery over at least two years of follow-up (Adán-Laguna et al., International Orthopaedics, 2026)
- Complications were less common than after surgery, but some patients needed a repeat treatment, and a minority went on to have surgery
- Pain relief may develop gradually over several weeks
Dr Carne and colleagues have submitted their own results for publication, describing the technique used here: Thermal Obliteration Approach with Sonographic Targeting (TOAST). The paper is currently under peer review, and we will add a link here once it is published.
Before your procedure
Please tell your clinician if you:
- Take blood-thinning medication (for example warfarin, apixaban, rivaroxaban or clopidogrel)
- Have diabetes
- Have a pacemaker or implanted electrical device
- Have a skin infection or wound on the foot
- Are unwell or have a fever
You may be given specific instructions about your medications before the procedure.
Preparing for the day
- Wash your foot on the day of the procedure
- Wear clean socks
- Bring or wear a loose-fitting shoe for the treated foot, to allow space for a bandage afterwards
- Eat and drink normally unless told otherwise
What happens during the procedure?
The procedure is usually performed as an outpatient or day-case procedure, and the visit usually lasts around 45–60 minutes. The steps usually include:
- Skin cleaning and sterile preparation
- Targeted local anaesthetic nerve blocks (a tibial nerve block and an intermetatarsal block)
- Ultrasound guidance to position a fine needle in the neuroma
- Radiofrequency energy delivered in short treatment cycles
- The needle may be repositioned slightly to treat the whole neuroma
- A small dressing and bandage are applied
The targeted nerve blocks are used to maximise comfort and allow precise treatment.
Will it hurt?
Most patients are comfortable during the procedure because of the nerve blocks. You may feel pressure during needle placement and mild, temporary discomfort during treatment. Your foot will usually feel numb for several hours afterwards.
After the procedure
You can usually go home the same day. You should:
- Keep the dressing dry for 24 hours
- Wear a loose-fitting shoe on the treated foot until swelling and bandaging have settled
- Avoid strenuous activity for around 2 weeks
- Walk gently as comfort allows
Some patients prefer to work from home for a few days, depending on their job.
Safety after nerve blocks
Until the numbness wears off, please:
- Take care when walking
- Avoid driving until normal sensation and control have returned
- Protect the foot from heat or injury
Recovery timeline (typical)
- First few days: local soreness or bruising is common. Pain may briefly flare before improving.
- 2–6 weeks: gradual improvement in pain.
- 6–12 weeks: maximum benefit is usually reached.
Risks and complications
Serious complications are uncommon.
Common or minor: temporary soreness, bruising, temporary numbness or tingling, a temporary increase in pain.
Uncommon: infection, bleeding, temporary nerve irritation.
Rare: persistent numbness, failure to improve symptoms.
Your clinician will discuss the risks specific to you.
When should I seek medical advice?
Contact your healthcare provider urgently if you develop:
- Increasing redness, swelling or discharge
- A fever
- Severe or worsening pain
- New or progressive numbness or weakness
Follow-up
You may be asked to complete symptom questionnaires, attend review appointments and continue foot rehabilitation exercises. Some patients may require repeat treatment.
Alternatives to RFA
Treatment depends on the severity and duration of symptoms, foot biomechanics and the response to previous treatments. Options range from observation to surgery.
| Treatment option | What it involves | Typical role | Key points |
|---|---|---|---|
| Do nothing (observation) | No active treatment | Mild or intermittent symptoms | Symptoms may remain stable, fluctuate or worsen; the condition is benign |
| Footwear and orthotics | Wider footwear, cushioned soles, orthoses | First-line treatment | Reduces forefoot pressure; may control mild to moderate symptoms |
| Calf stretching (slant board) | Regular calf stretching programme | Adjunct to conservative care | Useful if calf tightness contributes to forefoot overload |
| Physiotherapy | Gait, flexibility and strengthening work | Conservative management | Addresses biomechanics and load management |
| PMGR (calf release) | Surgical lengthening of a tight calf muscle | Selected cases | Considered when calf tightness is a major contributing factor |
| Steroid injection | Corticosteroid injection around the nerve | Short-term or diagnostic | Relief may be temporary; repeated injections are avoided |
| Radiofrequency ablation (RFA) | Heat energy to reduce nerve pain signals | Minimally invasive option | Does not remove the neuroma; good pain relief in many patients |
| Cryoablation | Cold energy to treat the nerve | Alternative to RFA | Not offered by our service |
| Surgery | Removal of the neuroma | Last-line treatment | Effective but higher risk; permanent numbness is common |
Choosing the right option
Your clinician will help guide your choice of treatment based on:
- Severity and duration of symptoms
- Foot structure and biomechanics
- Response to previous treatments
- Personal preference and activity levels
Not all treatments are appropriate for every patient, and progression through the options is often stepwise.
What happens if I do nothing?
Symptoms may stay the same, slowly worsen or occasionally improve. There is no risk of the condition spreading or becoming cancerous.
Procedure code (CCSD): A7300 – radiofrequency lesioning of a named peripheral nerve
If you have private medical insurance, please quote this code to your insurer to obtain pre-authorisation before your appointment. Each insurer decides its own cover and fees.
Who performs RFA?
Within Guildford Radiology Group, RFA for Morton’s neuroma is performed by Dr Andrew Carne, Consultant Musculoskeletal Radiologist.
Dr Carne also performs RFA for Morton’s neuroma in London at the London Foot and Ankle Centre, at the Hospital of St John & St Elizabeth, on alternate Tuesday afternoons. For appointments in London, please contact the London Foot and Ankle Centre directly by email at enquiries@tlfac.co.uk or by telephone on 020 7078 3800.
Arranging treatment
Before RFA can be booked, you will need a full consultation with Dr Carne. This allows him to confirm the diagnosis (usually with an ultrasound scan), review your previous treatments, discuss the risks and alternatives with you, and agree whether RFA is the right option.
To arrange a consultation, please email info@guildfordradiology.com or telephone 07591 798735.
RFA for Morton’s neuroma is covered by NICE guidance.
