Ultrasound guided non-surgical Morton’s neuroma treatments
Why are ultrasound guided procedures better in Morton’s neuroma treatment?
Morton’s neuroma is a fairly common foot condition that affects 1 of 3 individuals at some point in life. According to latest estimates, Morton neuroma is present in about 30 to 33% in general population(1). The classic symptoms include difficulty in walking (often feels like walking on marble/ pebble sensation) as well as numbness and burning sensation that may lead to varying degrees of walking difficulty and disability.
A history of ultrasound guided procedures for Morton’s neuroma:
Morton’s neuroma is a clinical diagnosis so a clear history and thorough physical examination by an experienced clinician is sufficient to make the diagnosis. Radiological tests like ultrasound have also been in use since 1957 for Morton’s neuroma in addition to MRI. But it was not until late 1990s when investigators started utilizing ultrasound guidance to administer minimally invasive therapies for more precise treatment(2).
Some frequently employed ultrasound guided therapies that are associated with excellent results in Morton neuroma management are:
How effective are ultrasound-guided procedures in the treatment of Morton’s neuroma?
Various research and studies indicate that the use of ultrasound in the treatment process increases the precision, accuracy and success of procedures. In a recent review comparing the use of ultrasound versus non ultrasound guided procedures published in the Journal of the American Podiatric Medical Association(3)concluded 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 concentrated sclerosing alcohol injections, can reduce the surgical referral rate, and can add efficacy to a single injection.”
Another example, is a recent study reported in the peer-reviewed journal Foot & Ankle International(4), which showed the technical success of ultrasound guided alcohol ablation procedures at 100%. Based on the data obtained from 87 courses of US guided alcohol ablations over a period of 14.3 months, about 91% of patients reported a remarkable improvement in the quality of symptoms. Likewise, study reported in Skeletal Radiology(5) suggested that 85% patients reported complete resolution of symptoms with an average of 1.6 treatment sessions of ultrasound guided radiofrequency ablation.
What is it about Ultrasound that helps so much?
According to a study conducted by Carolyn M. Sofka and associates(6), ultrasound guided procedures enable clinicians to:
- Clearly visualization of Morton neuroma while performing the procedure.
- Differentiate the neuromas from other possible causes of foot pain such as intermetatarsal bursae and metatarsophalangeal joint synovitis ; and,
- Visualize the tissue after the procedure to help confirm the accuracy of the procedure.
Why are ultrasound guided procedures so effective in the treatment of Morton’s neuroma?
Clinical data shows that the use of an ultrasound to guide the procedure increases the effectiveness of these conventional procedures many folds. According to the results of a recent extensive analysis published in the peer reviewed Journal of the American Podiatric Medical Association(3), some notable benefits of employing ultrasound-guided procedures are:
- Better targeting. Ultrasound guided procedures increase the chances of achieving complete resolution from the pain of a neuroma by targeting the lesion and minimizing the damage to surrounding normal tissues.
- Better with smaller neuromas. Ultrasound guided procedures are of especially helpful with smaller neuromas (less than 5mm in diameter).
- Lower risk of adverse effects or complications. For example, risk of abscess formation and nerve damage is fairly low with ultrasound-guided procedures due to accurate placement of the probe.
- Less repeat procedures. Ultrasound guided procedure are more accurate and effective and so minimize the need for repeat procedures
- Avoiding risks of surgery. By not performing surgery, you remove the risks of Morton’s neuroma surgery. Most patients achieve complete pain relief and quickly return to normal activities
In summary ultrasound guided procedures are very effective in treating Morton’s neuroma, especially when performed by clinicians experienced in these procedures.
- Bencardino, J., Rosenberg, Z. S., Beltran, J., Liu, X., & Marty-Delfaut, E. (2000). Morton’s neuroma: is it always symptomatic?. American Journal of Roentgenology, 175(3), 649-653.
- Masala, S., Fanucci, E., Ronconi, P., Sodani, G., Taormina, P., Romagnoli, A., & Simonetti, G. (2000). [Treatment of intermetatarsal neuromas with alcohol injection under US guide]. La Radiologia medica, 102(5-6), 370-373.
- Morgan, P., Monaghan, W., & Richards, S. (2014). A Systematic Review of Ultrasound-Guided and Non-Ultrasound-Guided Therapeutic Injections to Treat Morton’s Neuroma. Journal of the American Podiatric Medical Association, 104(4), 337-348.
- Musson, R. E., Sawhney, J. S., Lamb, L., Wilkinson, A., & Obaid, H. (2012). Ultrasound guided alcohol ablation of Morton’s neuroma. Foot & ankle international, 33(3), 196-201.
- Chuter, G. S., Chua, Y. P., Connell, D. A., & Blackney, M. C. (2013). Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal radiology, 42(1), 107-111.
- Sofka, C. M., Adler, R. S., Ciavarra, G. A., & Pavlov, H. (2007). Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection—preliminary results. HSS Journal, 3(1), 44-49.
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.