Ultrasound guided Morton’s neuroma treatments
Does ultrasound guidance improve the precision of Morton’s neuroma treatments?
Morton’s Neuroma is a very common condition of foot that can greatly compromise mobility and motion in the affected individuals. The prevalence of Morton’s neuroma is 30%-33% among the general population.
How effective are the ultrasound-guided procedures in the Morton’s neuroma management?
Besides lifestyle modification, a number of patients require other procedures to treat Mortons neuroma such as alcohol ablation, radiofrequency ablation, cryoablation etc. But how can one make these interventional procedures more precise and hazard-free?
Research and clinical studies show that the use of ultrasound guidance in these micro-invasive procedures can greatly increase the precision, success rate and accuracy of treatment protocols. A recent literature review concluded that ultrasound guidance reduces need for surgery by alleviating the symptoms associated with less invasive procedures(1).
The report success rates of ultrasound guided ablation varies from as high as a 100% success rate(1) to an 85% success rate. These patients had an average of only 1.6 sessions of ultrasound-guided radiofrequency treatment in the setting of chronic and symptomatic Morton neuroma.
How Ultrasound guidance adds value to procedures:
According to a new study by Carolyn M. Sofka and associates, ultrasound guidance offer superior results by:
- With the help of ultrasound, the clinician can directly visualize the neuroma and anatomical structures, making the procedure more successful;
- Ultrasound guidance also helps in confirming if the symptoms are in fact due to Mortons neuroma before the procedure. In addition, ultrasound technology also helps in differentiating Morton’s neuroma from other causes of foot pain such as metatarsophalangeal joint synovitis and intermetatarsal bursitis. This helps in determining the accuracy of therapy and to establish the prognosis.
Effectiveness of ultrasound guided procedures in Morton’s Neuroma treatment:
Based on the results of a study reported in the Journal of the American Podiatric Medical Association; some benefits of ultrasound guidance in the therapeutic management of Morton’s neuroma are:
- Better target:
The chances of achieving complete resolution are much higher if procedure is performed under ultrasound guidance. This is mainly because, US allows the practitioner to appropriately target the primary lesion. Likewise, the technique also reduces the duration of post-procedure rehabilitation by minimizing the damage to surrounding normal tissues.
- Excellent for small but symptomatic neuromas: Ultrasound guided procedures works best for smaller neuromas especially for neuroma with diameter of 5mm or less. Very small neuromas are hard to address or target with injection therapies in the absence of ultrasound guidance.
- Lesser risk of complications: Risk of adverse effects and complications can be reduced by improving the precision of needle insertion. For instance, the risk of damage to local tissues, abscess formation and damage to interdigital nerve is fairly low when ultrasound guided procedures are employed.
- Minimal requirement of repeat procedures: If injection or ablation therapy is not directed at the disease target, the patient may develop varying degrees of local side effects. In addition, if injection misses the target, you may require a repeat procedure to achieve desirable results.
- Lesser risk of surgery:
Risk of Morton’s neuroma surgery can be significantly reduced if effective non-invasive procedures are employed. Due to high precision of ultrasound-guided procedures, most patients achieve rapid remission and pain-free resolution of symptoms; thereby reducing the need of invasive surgeries.
Ultrasound guided procedures are therefore more effective and safe in the long term management of Morton’s neuroma. Speak to your healthcare practitioner if you have more questions on the types of ultrasound-guided therapeutic procedures.
- 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.
- Yap, L. P., & McNally, E. (2012). Patient’s assessment of discomfort during ultrasound‐guided injection of Morton’s neuroma: Selecting the optimal approach. Journal of Clinical Ultrasound, 40(6), 330-334.
- Ghozlan, R., & Zeitoun, F. (2013). THU0440 Effectiveneeffectiveness of ultrasound guided corticosteroids injections in interdigital morton’s neuroma a survey of 23 patients. Annals of the Rheumatic Diseases, 71(Suppl 3), 304-304.
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.