Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance

Mahadevan, Devendra; Attwal, Manjit; Bhatt, Raj; Bhatia, Maneesh

doi:10.1302/0301-620x.98b4.36880

Cited by 43 publications

(44 citation statements)

References 17 publications

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“…7 The use of ultrasound guidance does not seem to increase the success rate of the injection, compared to injections performed without guidance by an orthopaedic foot and ankle specialist. 8 One randomized trial has shown that at three and six months, local anaesthetic injections were as efficient for pain and function improvement as cases where corticosteroid was used in addition, 9 whereas another randomized trial had shown that injections containing corticosteroid were superior at three months. 10…”

Section: Nonoperative Managementmentioning

confidence: 99%

Morton’s interdigital neuroma: instructional review

2019

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The terminology ‘Morton’s neuroma’ may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve.Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of the condition, for differential diagnosis, are discussed.Nonoperative management is recommended initially. Physiotherapy, injections (local anaesthetic, steroid, alcohol), cryotherapy, radiofrequency ablation and shockwave therapy are discussed.Operative treatment is indicated after nonoperative management has failed. Neuroma excision has been reported to have good to excellent results in 80% of patients, but gastrocnemius release and osteotomies should be considered so as to address concomitant problems.Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique.Cite this article: EFORT Open Rev 2019;4:14-24. DOI: 10.1302/2058-5241.4.180025.

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Section: Nonoperative Managementmentioning

confidence: 99%

Morton’s interdigital neuroma: instructional review

2019

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“…We only found one study comparing the blind technique, based on anatomical landmarks, to the echo-guided technique. In that study, no significant differences were found between the injection methods, but the sample size (only 36 cases) constitutes a substantial limitation that might have prevented the study from reaching a statistically significant difference[ 24 ].…”

Section: Mn Treatmentmentioning

confidence: 99%

“…A recent retrospective case series study found a cut-off value of 6.3 mm, above which larger MN s failed to respond, as well as to corticosteroid injections[ 27 ]. Overall, most of the reported data in the literature do not support any influence of neuroma size on the outcome[ 23 , 24 , 28 ].…”

Section: Mn Treatmentmentioning

confidence: 99%

Role of imaging methods in diagnosis and treatment of Morton’s neuroma

Santiago¹,

Muñóz²,

Pryest³

et al. 2018

WJR

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Among the many causes of forefoot pain, Morton’s neuroma (MN) is often suspected, particularly in women, due to its high incidence. However, there remain controversies about its relationship with symptomatology and which diagnostic and treatment choices to choose. This article mainly focuses on the role of the various imaging methods and their abilities to support an accurate diagnosis of MN, ruling out other causes of forefoot pain, and as a way of providing targeted imaging-guided therapy for patients with MN.

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“…Real‐time assessment is another advantage of sonography and enables treatment of Morton neuromas by nonoperative injection of local anesthetic agents, alcohol, and corticosteroids into the affected space . In many cases, these treatments are performed under ultrasound guidance, which improves accuracy of the diagnosis.…”

mentioning

confidence: 99%

“…In many cases, these treatments are performed under ultrasound guidance, which improves accuracy of the diagnosis. However, the clinical effects of this approach remain controversial …”

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confidence: 99%

Intra‐ and Interobserver Reliability of Size Measurement of Morton Neuromas on Sonography

Park

Choi

et al. 2019

J of Ultrasound Medicine

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Objectives-Sonography is often used for analysis of Morton neuromas, but the measurement reliability is unknown. The aim of this study was to determine the intra-and interobserver reliability and precision of sonographic measurement of Morton neuromas.Methods-Three observers with different levels of sonography experience (observer A, expert; observer B, intermediate; observer C, beginner) performed repeated measurements of the size of Morton's neuroma in 20 patients. Intraclass correlation coefficient and limit of agreement were used to evaluate reliability and measurement precision.Results-The intraclass correlation coefficient for intraobserver reliability was 0.80, 0.71, and 0.43 (limit of agreement, 20%, 18%, and 47%) in observers A, B, and C, respectively. The intraclass correlation coefficient for interobserver reliability was 0.72, 0.38, and 0.38 (limit of agreement, 25%, 36%, and 35%) between observers A/B, A/C, and B/C, respectively. Conclusions-The intra-and interobserver reliability values for sonographic measurement of Morton neuroma size were dependent on observer experience. Experienced observers had higher reliability, while observers who were less familiar with sonography showed moderate to low reliability.

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Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance

Abstract: In the presence of a clear diagnosis of MN, a trained clinician who understands the forefoot anatomy may perform an injection without ultrasound guidance with good and safe results.

Cited by 43 publications

References 17 publications

Morton’s interdigital neuroma: instructional review

Morton’s interdigital neuroma: instructional review

Role of imaging methods in diagnosis and treatment of Morton’s neuroma

Intra‐ and Interobserver Reliability of Size Measurement of Morton Neuromas on Sonography

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