Infiltrative Therapy of Morton’s Neuroma A Systematic Review of Different Treatment Options

Main Article Content

Paolo Lorenzon
Carlo Rettore
Andrea Scalvi

Keywords

Morton's neuroma injection, Morton’s neuroma treatment, Morton’s neuroma review, Morton’s neuroma alcohol, Morton’s neuroma corticosteroid, Morton’s neuroma hyaluronic acid, Morton’s neuroma conservative treatment

Abstract

The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone infiltrative therapy for treatment of Morton’s neuroma. As many kinds of substances are injected, the main outcome defines which treatment provides the best results in term of patient’s satisfaction and pain relief, so that it would be possible to choose the best option.


Many electronic databases were searched on July 2021; we have included prospective and retrospective case series, and randomized controlled trials of infiltrative treatments in patients with primary diagnosis of Morton’s neuroma.


The search returned 25 studies which met the inclusion criteria, with a total of 2243 cases. The incidence of outcomes was extracted and analyzed.


Although many studies demonstrated favorable results in terms of pain relief and patient’s satisfaction employing different substances for infiltration, alcohol injection appears results on long run.

Abstract 476 | PDF Downloads 288

References

1. Jain S, Mannan K The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec 2013; 6:307-317
2. Wu KK Morton’s interdigital neuroma; a clinical review of its etiology, treatment, and result J Foot Ankle Surg 1996; 35:112-119
3. Levitsky KA, Alman BA, Jevsevar DS, Morehead J Digital nerves of the foot: anatomic variations and implications regarding the pathogenesis of interdigital neuroma. Foot and ankle 1993; 14:208-214
4. Hassouna H, Singh D, Morton’s metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg 2005;71 6:646-655
5. Bossley CJ, Cairney PC The intermetatarsophalangeal bursa, its significance inMorton’s metatarsalgia J Bone Joint Surg Br 1980; 63B2:184-187
6. Morscher E, Ulrich J, Dick W Morton’s intermetatarsal neuroma: morphology and histological substrate. Foot Ankle Int 2000; 21:558-562
7. Di Caprio F, Meringolo R, Shehab Eddine M, Ponziani L Morton’s interdigital neuroma of the foot: a literatura review. Foot Ankle Surg 2018; 24:92-98
8. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systemic reviews and meta-analysis: the PRISMA statement. PLoS Med 2009; 6:e1000097
9. Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D, Yeo ST,Russell IT, Gibson JN. Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial. J Bone Joint Surg Am. 2013 May 1;95(9):790-8, S1
10. Markovic M, Crichton K, Read JW, Lam P, Slater HK. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int. 2008 May;29(5):483-7
11. Park YH, Lee JW, Choi GW, Kim HJ. Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton's neuroma. Int Orthop. 2018 Feb;42(2):323-329
12. Saygi B, Yildirim Y, Saygi EK, Kara H, Esemenli T. Morton neuroma: comparative results of two conservative methods. Foot Ankle Int. 2005 Jul;26(7):556-9
13. Ruiz Santiago F, Prados Olleta N, Tomás Muñoz P, Guzmán Álvarez L, Martínez Martínez A. Short term comparison between blind and ultrasound guided injection in morton neuroma. Eur Radiol. 2019 Feb;29(2):620-627
14. Lizano-Díez X, Ginés-Cespedosa A, Alentorn-Geli E, Pérez-Prieto D, González-Lucena G, Gamba C, de Zabala S, Solano-López A, Rigol-Ramón P. Corticosteroid Injection for the Treatment of Morton's Neuroma: A Prospective, Double-Blinded,Randomized, Placebo-Controlled Trial. Foot Ankle Int. 2017 Sep;38(9):944-951
15. Hau MYT, Thomson L, Aujla R, Madhadevan D, Bhatia M. Medium-Term Results of Corticosteroid Injections for Morton's Neuroma. Foot Ankle Int. 2021 Apr;42(4):464-468
16. Makki D, Haddad BZ, Mahmood Z, Shahid MS, Pathak S, Garnham I. Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot Ankle Int. 2012 Sep;33(9):722-6
17. Mahadevan D, Attwal M, Bhatt R, Bhatia M. Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial. Bone Joint J. 2016 Apr;98-B(4):498-503
18. Mahadevan D, Salmasi M, Whybra N, Nanda A, Gaba S, Mangwani J. What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma? Foot Ankle Surg. 2016 Mar;22(1):9-11
19. Samaila EM, Ambrosini C, Negri S, Maluta T, Valentini R, Magnan B. Can percutaneous alcoholization of Morton's neuroma with phenol by electrostimulation guidance be an alternative to surgical excision? Long-term results. Foot Ankle Surg. 2020 Apr;26(3):314-319
20. Pasquali C, Vulcano E, Novario R, Varotto D, Montoli C, Volpe A. Ultrasound-guided alcohol injection for Morton's neuroma. Foot Ankle Int. 2015 Jan;36(1):55-9
21. Perini L, Perini C, Tagliapietra M, Varotto D, Valcarenghi A, Postorino A, Volpe A. Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions. Radiol Med. 2016 Jul;121(7):597-604
22. Pabinger C, Malaj I, Lothaller H, Samaila E, Magnan B. Improved Injection Technique of Ethanol for Morton's Neuroma. Foot Ankle Int. 2020 May;41(5):590-595
23. Hughes RJ, Ali K, Jones H, Kendall S, Connell DA. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR Am J Roentgenol. 2007 Jun;188(6):1535-9
24. Gurdezi S, White T, Ramesh P. Alcohol injection for Morton's neuroma: a five-year follow-up. Foot Ankle Int. 2013 Aug;34(8):1064-7
25. Lorenzon P, Rettore C. Mechanical Metatarsalgia as a Risk Factor for Relapse of Morton's Neuroma After Ultrasound-Guided Alcohol Injection. J Foot Ankle Surg. 2018 Sep-Oct;57(5):870-875
26. Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G. Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol. 2004 Mar;14(3):514-8
27. Musson RE, Sawhney JS, Lamb L, Wilkinson A, Obaid H. Ultrasound guided alcohol ablation of Morton's neuroma. Foot Ankle Int. 2012 Mar;33(3):196-201
28. - Mozena JD, Clifford JT. Efficacy of chemical neurolysis for the treatment of interdigital nerve compression of the foot: a retrospective study. J Am Podiatr Med Assoc. 2007 May-Jun;97(3):203-6
29. Campbell CM, Diamond E, Schmidt WK, Kelly M, Allen R, Houghton W, Brady KL, Campbell JN. A randomized, double-blind, placebo-controlled trial of injected capsaicin for pain in Morton's neuroma. Pain. 2016 Jun;157(6):1297-1304
30. Lee K, Hwang IY, Ryu CH, Lee JW, Kang SW. Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton's Neuroma. Foot Ankle Int. 2018 Feb;39(2):201-204
31. Shah R, Ahmad M, Hanu-Cernat D, Choudhary S. Ultrasound-guided radiofrequency ablation for treatment of Morton's neuroma: initial experience. Clin Radiol. 2019 Oct;74(10):815.e9-815.e13
32. Connors JC, Boike AM, Rao N, Kingsley JD. Radiofrequency Ablation for the Treatment of Painful Neuroma. J Foot Ankle Surg. 2020 May-Jun;59(3):457-461
33. Climent JM, Mondéjar-Gómez F, Rodríguez-Ruiz C, Díaz-Llopis I, Gómez-Gallego D, Martín-Medina P. Treatment of Morton neuroma with botulinum toxin A: a pilot study. Clin Drug Investig. 2013 Jul;33(7):497-503
34. Higgins JPT, Green S Cochrane handbook for systemic reviews of interventions. Version 5.0.0 The Cochrane Collaboration. 2011
35. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle_Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Ospital Research Institute. 2009
36. Lu VM, Puffer CP, Everson MC, Gilder HE, Burks SS, Spinner RJ. Treating Morton’s neuroma by injection, neurolysis, or neurectomy: a systemic review and meta-analysis of pain and satisfaction outcomes. Acta Neurochir 2021 Feb;163(2):531-543