Ultrasound-Guided Decompression of the Intermetatarsal Nerve for Morton's Neuroma: A Novel Closed Surgical Technique

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Alvaro Iborra-Marcos ◽  
Manuel Villanueva-Martinez ◽  
Stephen L. Barrett ◽  
Pablo Sanz-Ruiz
Keyword(s):  
Outpatient Surgery ◽  
Surgical Techniques ◽  
Normal Activity ◽  
Second Phase ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Simple Method ◽  
Postoperative Wound ◽  
Morton's Neuroma ◽  
Neurovascular Damage

Background This study describes the technique for decompression of the intermetatarsal nerve in Morton's neuroma by ultrasound-guided surgical resection of the transverse intermetatarsal ligament. This technique is based on the premise that Morton's neuroma is primarily a nerve entrapment disease. As with other ultrasound-guided procedures, we believe that this technique is less traumatic, allowing earlier return to normal activity, with less patient discomfort than with traditional surgical techniques. Methods We performed a pilot study on 20 cadavers to ensure that the technique was safe and effective. No neurovascular damage was observed in any of the specimens. In the second phase, ultrasound-guided release of the transverse intermetatarsal ligament was performed on 56 patients through one small (1- to 2-mm) portal using local anesthesia and outpatient surgery. Results Of the 56 participants, 54 showed significant improvement and two did not improve, requiring further surgery (neurectomy). The postoperative wound was very small (1–2 mm). There were no cases of anesthesia of the interdigital space, and there were no infections. Conclusions The ultrasound-guided decompression of intermetatarsal nerve technique for Morton's neuroma by releasing the transverse intermetatarsal ligament is a safe, simple method with minimal morbidity, rapid recovery, and potential advantages over other surgical techniques. Surgical complications are minimal, but it is essential to establish a good indication because other biomechanical alterations to the foot can influence the functional outcome.

Effectiveness of Ultrasound-Guided Corticosteroid Injection in the Treatment of Morton's Neuroma

2008 ◽  
Vol 29 (5) ◽  
pp. 483-487 ◽  
Author(s):  
Maja Markovic ◽  
Ken Crichton ◽  
John W. Read ◽  
Peter Lam ◽  
Henry Kim Slater
Keyword(s):  
Corticosteroid Injection ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Morton's Neuroma

A Systematic Review of Ultrasound-Guided and Non–Ultrasound-Guided Therapeutic Injections to Treat Morton's Neuroma

2014 ◽  
Vol 104 (4) ◽  
pp. 337-348 ◽  
Author(s):  
Peter Morgan ◽  
Wendy Monaghan ◽  
Simon Richards
Keyword(s):  
Systematic Review ◽  
Ultrasound Guidance ◽  
Extraction Process ◽  
Evidence Base ◽  
Injection Therapy ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Painful Condition ◽  
Therapeutic Outcomes ◽  
Morton's Neuroma

Background Morton's neuroma is a frequently painful condition of the forefoot, causing patients to seek medical care to alleviate symptoms. A plethora of therapeutic options is available, some of which include injection therapies. Researchers have investigated injection therapy for Morton's neuroma, and latterly the evidence base has been augmented with methods that use diagnostic ultrasound as a vehicle to deliver the injectate under image guidance for additional accuracy. To date, there seems to be no consensus that ultrasound-guided injections provide better therapeutic outcomes than nonguided injections for the treatment of Morton's neuroma. Methods A systematic review was chosen because this method can undertake such a process. The review process identified 13 key papers using predetermined inclusion and exclusion criteria, which then underwent methodological quality assessment using a pretested Quality Index. A narrative synthesis of the review findings is presented in light of the heterogeneity of the data from the extraction process. Results This systematic review provides an argument that ultrasound guidance can produce better short- and long-term pain relief for corticosteroid injections, can reduce the need for additional procedures in a series of sclerosing alcohol injections, can reduce the surgical referral rate, and can add efficacy to a single injection. Conclusions Ultrasound guidance should be considered for injection therapy in the management of Morton's neuroma.

Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma

2017 ◽  
Vol 39 (2) ◽  
pp. 201-204 ◽  
Author(s):  
Kang Lee ◽  
Il-Yeong Hwang ◽  
Chang Hyun Ryu ◽  
Jae Woo Lee ◽  
Seung Woo Kang
Keyword(s):  
Hyaluronic Acid ◽  
Case Series ◽  
Functional Improvement ◽  
X Rays ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Hyaluronic Acid Injection ◽  
Acid Injection ◽  
Morton's Neuroma

Background: Morton’s neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton’s neuroma. Methods: Eighty-three patients with Morton’s neuroma in their third intermetatarsal space with definite Mulder’s click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Results: Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. Conclusion: In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton’s neuroma. However, numbness associated with Morton’s neuroma should be addressed more cautiously since it may persist without much improvement. Level of Evidence: Level IV, retrospective case series.

scholarly journals Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Steven R. Edwards ◽  
Susannah Fleming ◽  
Karl B. Landorf
Keyword(s):  
Primary Outcome ◽  
Event Rate ◽  
Corticosteroid Injection ◽  
Adverse Event Rate ◽  
Ultrasound Guided ◽  
Medium Term ◽  
Morton’S Neuroma ◽  
Morton's Neuroma ◽  
Corticosteroid Injections

Background Morton's neuroma is a common condition that routinely presents in podiatric practice. The aim of this study was to systematically synthesize the evidence relating to the effectiveness of a corticosteroid injection for Morton's neuroma. Methods Studies with a publication date of 1960 or later were eligible, and searches were performed within the Turning Research Into Practice database; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register; MEDLINE (Ovid); PubMed; Embase; Cumulative Index to Nursing and Allied Health Literature; and the gray literature. Study selection criteria included randomized and nonrandomized controlled trials where a single corticosteroid injection for Morton's neuroma pain was investigated. The primary outcome was Morton's neuroma pain as measured by any standard validated pain scale. Results Ten studies involving 695 participants were included. The quality of the studies was considered low and subject to bias. Of the included studies, five compared corticosteroid injection to usual care, one compared corticosteroid injection to local anesthetic alone, one compared ultrasound-guided to non–ultrasound-guided injections, three compared corticosteroid injections to surgery, one compared small to large neuromas, six assessed patient satisfaction, four measured adverse events, one studied return to work, and one examined failure of the corticosteroid injection to improve pain. Overall, these studies identified a moderate short- to medium-term benefit of corticosteroid injections on the primary outcome of pain and a low adverse event rate. Conclusions A single corticosteroid injection appears to have a beneficial short- to medium-term effect on Morton's neuroma pain. It appears superior to usual care, but its superiority to local anaesthetic alone is questionable, and it is inferior to surgical excision. A very low adverse event rate was noted throughout the studies, indicating the intervention is safe when used for Morton's neuroma. However, the quality of the evidence is low, and these findings may change with further research.

Ultrasound Guided Alcohol Ablation of Morton's Neuroma

2012 ◽  
Vol 33 (3) ◽  
pp. 196-201 ◽  
Author(s):  
Rachel E. Musson ◽  
Jasdev S. Sawhney ◽  
Leslie Lamb ◽  
Antony Wilkinson ◽  
Haron Obaid
Keyword(s):  
Case Series ◽  
Visual Analogue Score ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Alcohol Injection ◽  
Alcohol Ablation ◽  
Morton's Neuroma

Background: Morton's neuroma is a common cause of metatarsalgia. This study evaluated the efficacy of ultrasound guided alcohol injection as a treatment for this condition. Method: Data from 87 treatment courses were included in this study with a mean follow of 14.3 months. Results: Technical success was 100%. One patient developed symptoms consistent with an allergic reaction to the injection and one patient declined further injection because of periprocedural pain. Partial or total treatment response was achieved in 66%, with 32% of patients having complete resolution of pain. The median visual analogue score (VAS) decreased from 8 pre-procedure to 4 post-procedure ( p < 0.0001). Procedural success was greater in patients under 55 years old and in those with solitary neuromas. Seventeen patients (20%) went on to have surgery due to continuing pain. Conclusion: Ultrasound guided alcohol ablation for the treatment of Morton's neuroma was a safe procedure that significantly reduced pain and may offer an alternative therapy to surgery. Level of Evidence: IV; Retrospective Case Series

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