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Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma

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Abstract

Objective

To identify the benefits of ultrasound-guided radiofrequency ablation of Morton’s neuroma as an alternative to surgical excision.

Materials and methods

We studied a consecutive cohort of surgical candidates for Morton’s neurectomy who we referred, instead, for radiofrequency ablation (RFA). Under local anaesthetic, RFA was performed under ultrasound guidance, by a single radiologist. This out-patient procedure was repeated after 4 weeks if necessary. We followed patients for a minimum of 6 months to assess their change in visual analogue pain scores (VAS), symptom improvement, complications and progression to surgical excision.

Results

Thirty feet in 25 patients were studied. There were 4 men and 21 women with an average age of 55 years (range 33–73 years). All had tried previous methods of conservative management. Forty percent presented with 2nd space neuromas and 60% with 3rd space ones. The average number of treatment sessions was 1.6 (range 1–3, mode 1). Prior to treatment, all patients had pain on activity (VAS average: 6.0, range 3–9). Post-treatment there was a statistically significant reduction in pain scores (post-RFA VAS average: 1.7, range 0–8, p < 0.001). The average overall symptom improvement was 76%. There was one minor complication of temporary nerve irritation. Three neuromas (10%) have progressed to surgical excision; 1 patient has ongoing, unchanged pain with no obvious cause. At 6 months, 26 out of 30 feet had a satisfactory outcome.

Conclusion

Ultrasound-guided RFA has successfully alleviated patients’ symptoms of Morton’s neuroma in >85% of cases. Only 10% have proceeded to surgical excision in the short term.

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Acknowledgements

No benefits have been received by the authors from any commercial party related to the subject of this article.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics, Darlington Memorial Hospital, Darlington, County Durham, DL3 6HX, UK

    Graham S. J. Chuter

  2. Department of Orthopaedic Surgery, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Yeok Pin Chua

  3. Department of Medicine, Monash University, Melbourne, Australia

    David A. Connell

  4. The Park Clinic, 166 Gipps Street, East Melbourne, VIC, 3002, Australia

    Mark C. Blackney

Authors
  1. Graham S. J. Chuter
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  2. Yeok Pin Chua
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  3. David A. Connell
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  4. Mark C. Blackney
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Corresponding author

Correspondence to Graham S. J. Chuter.

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Chuter, G.S.J., Chua, Y.P., Connell, D.A. et al. Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal Radiol 42, 107–111 (2013). https://doi.org/10.1007/s00256-012-1527-x

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  • DOI: https://doi.org/10.1007/s00256-012-1527-x

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