Ultrasound-Guided Percutaneous Radiofrequency for the Treatment of Morton’s Neuroma

Masala, Salvatore; Cuzzolino, Alessandro; Morini, Marco; Raguso, Mario; Fiori, Roberto

doi:10.1007/s00270-017-1786-y

Cited by 14 publications

(23 citation statements)

References 24 publications

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“…Studies took place in United Kingdom (6 studies) [2, 7, 22, 39, 40, 50], Italy (5 studies) [8, 20, 23, 53, 55], United States of America (4 studies) [4, 5, 19, 49], Australia [1, 10], South Korea [52, 54], Spain [6, 41] and Turkey [3, 9] (2 studies each) and South Africa [48] and France [51] (1 study each). Clinical settings represented were Hospital (9 studies) [3, 8, 9, 22, 39, 41, 50, 52, 54], University [2, 6, 19, 20, 23, 48, 56] and Radiology [1, 7, 10, 49, 51, 53, 55] (7 studies each), and Private Practice (2 studies) [4, 5]. The study types consisted of seven RCTs [3, 39–41, 48, 50, 52], and 18 pre/post case series [1, 2, 4–10, 19, 20, 22, 23, 49, 51, 53–55].…”

Section: Resultsmentioning

confidence: 99%

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The effectiveness of non‐surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta‐analysis

Matthews

Hurn

Harding

et al. 2019

Journal of Foot and Ankle Research

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Background Morton’s neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN. Methods Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton’s neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the I 2 statistic. Results A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to − 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to − 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality. Conclusions Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. Although the evidence base is expanding, further high quality RCTs are needed. Electronic supplementary material The online version of this article (10.1186/s13047-019-0320-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Three pre/post case series investigating radiofrequency ablation [9, 10, 53] found a large reduction in pain (WMD: -51.7; 95%CI: -77.1 to − 26.3) (Fig. 6) but an RCT is required to confirm these findings.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of non‐surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta‐analysis

Matthews

Hurn

Harding

et al. 2019

Journal of Foot and Ankle Research

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“…A variety of US-guided procedures have been used for the treatment of MN, with the most popular being injections of corticosteroids and local anesthetic, chemical neurolysis, and radiofrequency ablation (22)(23)(24)(25) . Treatment choice largely depends on the experience of the treating physician, with surgeons preferring surgical management over less invasive options.…”

Section: Outcomes Of Us-guided Treatment Of Mnmentioning

confidence: 99%

Ultrasound-guided treatment of Morton’s neuroma

et al. 2021

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Morton’s neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton’s neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton’s neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton’s neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton’s neuroma, with emphasis on the outcomes of ultrasound-guided treatments.

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Section: Mn Treatmentmentioning

confidence: 99%

“…Percutaneous radiofrequency ablation[ 34 ] has also been used in patients unresponsive to conservative therapies. The reported success with radiofrequency ranges from 68% to 100%, probably influenced by technical factors such as variability in the number of ablation cycles and in patient’s inclusion criteria[ 34 , 35 ]. A case series using cryoablation showed that 77.7% of patients were completely satisfied following treatment, but this result needs to be confirmed by further prospective studies in order to be considered a valid alternative to radiofrequency ablation[ 36 ].…”

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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Ultrasound-Guided Percutaneous Radiofrequency for the Treatment of Morton’s Neuroma

Abstract: RF is a safe, efficient, and minimally invasive technique for the treatment of symptomatic MN.

Cited by 14 publications

References 24 publications

The effectiveness of non‐surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta‐analysis

The effectiveness of non‐surgical interventions for common plantar digital compressive neuropathy (Morton's neuroma): a systematic review and meta‐analysis

Ultrasound-guided treatment of Morton’s neuroma

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

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