Efficacy of Corticosteroid Injection versus Size of Plantar Interdigital Neuroma

Abstract

A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.

What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?

“…We found that as the size of the neuroma increased, the probability of needing further intervention within 2 years increased. This corresponds with the findings of Makki et al [9], where patients with neuromas larger than 5 mm had overall worse pain scores by six months post injection compared to neuromas less than 5 mm. In their study however, the neuromas were measured in the sagittal plane using ultrasonography whereas our radiologists recorded the largest diameter measurable in either the sagittal or coronal planes.…”

“…Twenty nine feet (51%) received further treatment in the form of one additional corticosteroid injection (11 cases, 19%) and surgical excision (18 cases, 32%). Patients who did not receive further treatment had significantly smaller neuromas (median of 8 mm [7][8][9][10][11][12] versus 10 mm [8.5-14.5]) and were older (mean of 59.4 AE 9.3 years versus 51.6 AE 12.4 years) ( Table 1).…”

“…In a study by Bennett et al [7], where patients received graded conservative, injection and surgical treatment if symptoms had not sequentially improved, 21% required eventual surgery. Makki et al [9] examined the efficacy of corticosteroid injections for MN and its relationship to patient and neuroma factors. It concluded that patients with neuromas of less than 5 mm had better symptom relief up to six months following corticosteroid injection, although this difference diminished with time.…”

Long-Term Results of Neurectomy Through a Dorsal Approach in the Treatment of Morton’s Neuroma

“…The initial treatment of metarsalgia is mainly conservative [1][2][3]18] and includes the use of pads and orthopedic shoes, rehabilitation, and steroid and anesthetic injections [27,[29][30][31]. Makki et al [32] concluded that a single ultrasound-guided corticosteroid injection results in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.…”

Ultrasound-guided intervention in the ankle and foot

“…Most studies have shown that ultrasound-guided steroid injections are both effective and cost effective for short-term pain relief usually at 3 months, with the effect ranging between 4 weeks and 9 months and being more significant and long lasting if the injection is delivered early in the course of symptoms and for lesions ,5 mm. [75][76][77][78][79] Ultrasound-guided alcohol injections are an alternative effective treatment. Partial or total pain relief has been reported in up to 94% of patients at 6 months and in 74% of patients at 1 year after the injection, with 30% ultrasound-proven reduction in lesion size at 6 months.…”