Morton’s neuroma Platelet Rich Plasma injections
When to use Platelet Rich Plasma injections in Morton’s neuroma?
Morton’s neuroma is clinically defined as a progressive entrapment neuropathy that of the plantar digital nerve. Besides 3rd and 4th metatarsal region, a fair number of cases are also reported in the first two inter-metatarsal spaces.
Fortunately, nearly all cases of Morton’s neuroma are managed by non-surgical methods initially with conservative measures and if necessary ultrasound guided ablation procedures. Although, more than 90% patients achieve complete remission or remarkable improvement in the intensity of pain symptoms; about 10% patients does require micro-invasive therapies or surgical intervention to maintain normal quality of life.
Platelet Rich Plasma Injections – a brief overview:
Platelet rich plasma therapy (abbreviated as PRP) is the re-administration of the patient’s own platelets to activate the body’s natural healing cascade for repair and regeneration(1). PRP has been successfully used for the management of several musculoskeletal conditions such as ligamentous tear, joint inflammatory disorders, tore tendons and muscular ailments(2). PRP is prepared by centrifuging a small amount of patient’s blood to obtain a platelet-rich sample. The platelets are activated and then injected. In most cases, the treatment can be completed in one session; however, multiple courses of PRP can be safely performed depending upon the response to the therapy and clinical indications.
The treatment exert positive effects via multiple mechanisms including:
- Activation and release of the body’s natural growth factors in the abnormal tissue. This response has been proven to stimulate the tissue regeneration processes.
- Localized inflammatory response that increases the blood flow to the abnormal tissue.
- Limitation of scar tissue formation.
Indications for Platelet Rich Plasma injection in Morton’s neuroma management:
- Morton’s neuroma refractory to conservative treatments: Most cases of Morton’s neuroma responds to conservative care or ultrasound guided ablation procedures. However, if symptoms does not improve, PRP can be used as a final step before resorting to surgery.
- Morton’s neuroma with co-existing musculoskeletal lesions: Morton’s neuroma often co-exists with other lesions of muscles and joints such as bursitis, plantar fasciitis and arthritis. In all these cases, platelet rich plasma injections are not only safe but a preferred therapy to alleviate these other conditions as well as Morton’s neuroma.
- Routinely after Morton’s neuroma surgery: Surgical intervention is sometimes necessary to treat refractory cases of Mortons neuroma. Platelet rich plasma injections can be used to hasten the pace of recovery after Mortons neuroma surgery.
- To treat pain or complications after Morton’s neuroma surgery: Even with best practices and aseptic care, the risk of complications of Mortons neuroma surgery is fairly high. For example, tendon exposure, fibrosis, scarring and wound dehiscence are some complications that are often reported in patients after surgical repair.
Platelet Rich Plasma injections can be very helpful in post Morton’s Neuroma surgery pain. In fact, we often recommend Platelet Rich Plasma injections in post Morton’s neuroma surgery pain cases. Your body’s natural growth factors can be very helpful in fighting some of the complications that can occur with Morton’s Neuroma surgery. In fact, we’ve had some great results with PRP in patients with post Morton’s neuroma surgery pain.
Complications from PRP injections
Platelet rich plasma injection therapy is usually well-tolerated by patients. In a small percentage of individuals, mild complications/ adverse effects are observed such as:
- Irritation or redness at the injection site
- Localized pain and discomfort
- Bruising of surrounding skin
Most of these side effects are temporary and resolve spontaneously within a couple of days after the initial procedure. You can also use non-steroidal anti-inflammatory drugs or over-the-counter analgesics to resolve these temporary symptoms.
Improving the quality of results with PRP Injections
The results of platelet rich plasma therapy can be further improved by using ultrasound guidance to increase the precision of the injection. Additionally, ultrasound guided PRP injections are associated with minimizing the risk of post-procedure pain and discomfort.
Any contraindications to Platelet Rich Plasma Injections?
Although the treatment is generally well-tolerated by individuals of all age groups, there are certain contraindications to PRP Injections. For example:
- Recent history of anti-coagulant therapy/ course
- Bleeding disorders
- Pregnant or breastfeeding mothers
- Active malignancy, severe infection or thrombocytopenia
- Murawski, C. D., Smyth, N. A., Newman, H., & Kennedy, J. G. (2014). A Single Platelet-Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy A Retrospective Preliminary Analysis. Foot & ankle specialist, 1938640014532129.
- Abate, M. (2013). Hyaluronic Acid and Platelet Rich Plasma in Hip Osteoarthritis: Work in Progress. Surgery Curr Res, 3, e110.
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.