I can't really speak to temperature effects. Mine started in late spring/early summer, and when the weather got cold it was bad enough I was laying off it completely.

You basically have 3 options for non-surgical interventions:

-Different footwear and/or neuroma pads: Footwear changes may be an option for summer, but probably not for skiing. Neuroma pads did nothing for me, but YMMV and since they cost almost nothing they're worth trying just to see. Make no mistake though, any nerve damage bad enough to be symptomatic is probably irreversible. You can do your best to keep it from getting worse, but shoes and pads won't "cure" anything.

-Dilute alcohol injections: These are supposed to kill the nerve in situ, but my surgeon's opinion was that they were a scam.

-Cortisone injections. Cortisone injections also did nothing for me. They may help if you identify symptoms very early, but anything beyond very minor damage to the nerve is irreversible. IMO, if "brutal" is how you would describe the pain level, the cortisone injections are a waste of time and money.


If you get surgery I highly recommend finding a well regarded foot/ankle specific ortho who works with athletes. The biggest factor in whether or not the surgery "works" is what the surgeon does with the end of the nerve. According to my guy, lots of podiatrists just snip it right above the neuroma and call it good. This can be OK in sedentary people, but if you are active it can often lead to a stump neuroma (google this) that can be as bad as the original neuroma. My surgeon removed the nerve well above the MTP joint and inserted the end into one of the intermetatarsal muscles. The nerve end has more space there and being inserted into the muscle reduces stump growth, supposedly.

Also, take the recovery seriously. I needed to be on the couch with the foot elevated >90% of the time for the first 3-4 days or it would throb horribly, and I had to keep it elevated the majority of the time for another week or so. After I got out of the ortho shoe and got the stitches out (2 wks) I had to take it very easy for a couple more weeks still. You really need to be off the foot as much as possible for 1-2 months, which isn't too bad if you have a desk job but could be tough if your jobs requires you to be on your feet. Full recovery expect 3-6 months depending on how seriously you take the recovery and whether or not you have any complications.