Operative treatment options for Morton’s neuroma other than neurectomy − a systematic review

Choi, Jun Young; Hong, Woi Hyun; Kim, Min Jin; Chae, Su Whi; Suh, Jin Soo

doi:10.1016/j.fas.2021.10.011

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…Pero sugirió realizar estudios para analizar la relación costo beneficios de estas intervenciones. Choi et al (2022) coincide que la evidencia disponible no es tan sólida para determinar que las intervenciones no quirúrgicas sean mejores que las cirugías para tratar el neuroma. Asimismo, aconsejaron que se debe tener cuidado con la liberación mínimamente invasiva del ligamento intermetatarsiano transversal profundo.…”

Section: Discussionunclassified

Neuroma de Morton: tratamiento fisioterapéutico versus cirugía - revisión bibliográfica

Llundo Chango,

Cantuña Vallejo

2023

Pentaciencias

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El neuroma de Morton (NM) se produce por afectación del nervio interdigital localizado entre el tercer y cuarto metatarsiano. El tratamiento es multidisciplinario se encuentra orientado a aliviar el dolor. Las alternativas disponibles incluyen procedimientos quirúrgicos y terapia física. El objetivo del estudio fue brindar una visión integral de los tratamientos disponibles que los profesionales de la salud pueden aplicar eligiendo la mejor opción y terapia individual para cada paciente. La metodología consistió en realizar una búsqueda de artículos científicos en las bases de daros PubMed, Google Académico y Springerlink. Para ello, se combinaron palabras claves como Morton's neuroma, surgery, physiotherapy, combinadas con los operadores booleanos AND, OR y NOT. En los resultados se determinó que la terapia física se indica para el tratamiento del dolor incluso antes de la cirugía o cuando los pacientes no son candidatos para una intervención quirúrgica. Su efecto máximo dura alrededor de 6 meses. En cambio, la cirugía puede reducir las molestias completamente. Se concluyó que de acuerdo con la evidencia analizada las cirugías son el tratamiento de elección debido a que a largo plazo los pacientes experimentan una reducción total del dolor y los efectos se mantienen el tiempo.

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Section: Discussionunclassified

Neuroma de Morton: tratamiento fisioterapéutico versus cirugía - revisión bibliográfica

Llundo Chango,

Cantuña Vallejo

2023

Pentaciencias

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“…Surgical resection is a third-line intervention with excellent long term results (8,14) but is generally reserved for the most chronic debilitating cases. Surgery may carry adverse events such as neuralgia, paraesthesia, recurrent pain, infection, floating toe, and chronic regional pain syndrome, with occurrence rates ranging from 5-37% dependent on type (15). Two second-line alternatives to surgery gaining traction among practitioners are guided ablation therapies: ethanol ablation (ETA) and radiofrequency ablation (RFA).…”

Section: Discussionmentioning

confidence: 99%

“…These techniques retract or separate soft tissue structures around the plantar digital nerve (42). A recent systematic review found these procedures lack robust evidence using validated outcome measures, although they reported excellent satisfaction and subjective pain relief (15). A meta-analysis comparing injection, neurolysis and neurectomy reported lower satisfaction and pain relief scores with injections compared to neurolysis (6).…”

Section: Discussionmentioning

confidence: 99%

“…The use of PROMs should not be limited to second-line interventions. Surgical interventions, a third-line option for Morton's neuroma have yet to explore these options, although they come highly recommended for future research (15). Decompressing the nerve tissue extends to surgical procedures such as neurolysis or Minimally Invasive Nerve Decompression (42).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of radiofrequency ablation versus ethanol ablation for Morton's neuroma: a clinical trial using patient recorded outcome measures

Silvester

Nargahi²,

Woods

et al. 2022

Preprint

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Background Morton’s neuroma is a common cause of forefoot pain and can be difficult to treat. Ethanol ablation (ETA) and Radiofrequency ablation (RFA) are increasingly used for treatment of chronic Morton's neuroma. However, there is limited evidence on the effectiveness of these guided ablation therapies in relation to broad-ranging patient recorded outcome measures (PROMs), and prospective studies directly comparing the two interventions are lacking. In this pragmatic clinical trial, we aimed to compare the efficacy of Ethanol ablation (ETA) and Radiofrequency ablation (RFA) on patient recorded outcome measures (PROMs) in pain, function, and ability in patients with Morton's neuroma. Methods Participants with chronic Morton's neuroma were randomly assigned to either ETA or RFA. Outcome measures were the Visual Analogue Scale (VAS), the eight-domain Foot Health Status Questionnaire (FHSQ) and the Foot and Ankle Ability Measure (FAAM). These were assessed at baseline, three, and six months after treatment. Results Sixty-three participants were allocated to either RFA (n=35) or ETA (n=28). A slight decrease in pain ascertained through VAS scores was observed in both intervention groups over six months relative to baseline. FAAM scores moderately improved in both groups over six months, with ETA showing a marginally greater mean change compared to RFA (3.8 points; p=0.004). FHSQ scores improved from baseline to six months in both groups, across all domains except vigour, which decreased in both interventions over three months and then stabilised in the ETA group at six months. Between-group differences of minor clinical importance favouring the ETA group were reported in improvement from baseline to six months of foot pain (3.7 points on 100 point scale; p<0.005), foot function (3.3 points; p=0.017), general health (2.5 points; p=0.013), and physical activity (11.0 points; p<0.001). Conclusion In the treatment of chronic Morton’s neuroma, ETA and RFA appear to confer comparable six-month improvements in pain, foot health, function, and ability. Multi-dimensional scales such as the FHSQ and the FAAM potentially elicit substantial treatment-related improvements that are not evident from VAS. Accordingly, incorporation of diverse PROMs into clinical assessments may enhance therapeutic decision-making and research in this context. Trial registration Australian New Zealand Trials Registry (ANZCTR) ACTRN12622000912785 (retrospectively registered on 27/06/2022

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“…[23][24][25] Morton neuromas have multiple treatment options including injections, neurolysis, and neurectomy. There have been several reviews and meta-analyses [26][27][28] that have not reached a clear consensus, though one theme is that neurolysis and neurectomy result in more favorable outcomes than injections. 26 Other studies have shown that ethanol ablation provides greater short-term relief than corticosteroids and that RFA has also been noted to be effective as a second-line therapy when ethanol-based neurolysis fails.…”

Section: Peripheral Neurolytic Blocksmentioning

confidence: 99%

Agents Used for Nerve Blocks and Neurolysis

Majdalany

Lilly

et al. 2022

Semin intervent Radiol

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The recognition of pain and the treatments used for it are vital for all practitioners. Many types of pain can be treated in a locoregional fashion, which has significant implications not just for any individual patient but for society as a whole. These treatments are most effective when performed in a minimally invasive, image-guided fashion. Interventional radiologists should play a central role in providing these lifestyle-limiting treatments. This article describes the medications most typically used for spinal and extra-axial treatments in the management of patients in pain.

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Operative treatment options for Morton’s neuroma other than neurectomy − a systematic review

Cited by 6 publications

References 35 publications

Neuroma de Morton: tratamiento fisioterapéutico versus cirugía - revisión bibliográfica

Neuroma de Morton: tratamiento fisioterapéutico versus cirugía - revisión bibliográfica

Efficacy of radiofrequency ablation versus ethanol ablation for Morton's neuroma: a clinical trial using patient recorded outcome measures

Agents Used for Nerve Blocks and Neurolysis

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