Skip to main content
SpringerLink
Log in

Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance

  • Clinical Investigation
  • Musculoskeletal Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the technical success, safety and early efficacy of Morton neuroma (MN) cryoneurolysis.

Materials and Methods

Retrospective review of 54 consecutive patients with MN treated with cryoneurolysis after failure of conservative treatment, from September 2022 to June 2023. Outcomes measurements included technical success (defined a successful ultrasound-guided placement of the cryoprobe), procedural safety according to Cirse classification and change in 6 months post-procedure by pain numeric rating scale (pNRS).

Results

A total of 59 MN were treated during 55 procedures. Mean procedure duration was 47 min, all patients were discharged 2 h after the intervention. Technical success was 98.1%. No Cirse grade 3, 4 or 5 complication was reported. Three grade 2 complication occurred, including two chilblain-type lesions and one bone insufficiency fracture. At 6 months post-procedure, pNRS score was significantly decreased (2.7 ± 2.2 vs 7.1 ± 1.1) (p < 0.0001), with a mean score decrease of 4.1points. Thirty-two patients (60.4%) reported a complete pain relief, 15 (28.3%) a partial pain relief and 6 (11.3%) no pain relief, or increased pain.

Conclusion

Cryoneurolysis seems to be safe for the treatment of Morton neuroma. Six-month pain relief is promising and needs to be confirmed at long term.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hodes A, Umans H. Metatarsalgia. Radiol Clin North Am. 2018;56:877–92. https://doi.org/10.1016/j.rcl.2018.06.004.

    Article  PubMed  Google Scholar 

  2. Bhatia M, Thomson L. Morton’s neuroma–current concepts review. Journal of Clinical Orthopaedics and Trauma. 2020;11:406–9. https://doi.org/10.1016/j.jcot.2020.03.024.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hau MYT, Thomson L, Aujla R, et al. Medium-term results of corticosteroid injections for Morton’s neuroma. Foot Ankle Int. 2021;42:464–8. https://doi.org/10.1177/1071100720966332.

    Article  PubMed  Google Scholar 

  4. Womack JW, Richardson DR, Murphy GA, et al. Long-term evaluation of interdigital neuroma treated by surgical excision. Foot Ankle Int. 2008;29:574–7. https://doi.org/10.3113/FAI.2008.0574.

    Article  PubMed  Google Scholar 

  5. Gurdezi S, White T, Ramesh P. Alcohol injection for Morton’s neuroma: a five-year follow-up. Foot Ankle Int. 2013;34:1064–7. https://doi.org/10.1177/1071100713489555.

    Article  PubMed  Google Scholar 

  6. Chuter GSJ, Chua YP, Connell DA, Blackney MC. Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal Radiol. 2013;42:107–11. https://doi.org/10.1007/s00256-012-1527-x.

    Article  PubMed  Google Scholar 

  7. Cazzato RL, Garnon J, Ramamurthy N, et al. Percutaneous MR-guided cryoablation of Morton’s neuroma: rationale and technical details after the first 20 patients. Cardiovasc Intervent Radiol. 2016;39:1491–8. https://doi.org/10.1007/s00270-016-1365-7.

    Article  PubMed  Google Scholar 

  8. Ilfeld BM, Finneran JJ. Cryoneurolysis and percutaneous peripheral nerve stimulation to treat acute pain. Anesthesiology. 2020;133:1127–49. https://doi.org/10.1097/ALN.0000000000003532.

    Article  PubMed  Google Scholar 

  9. Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the Cirse classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  PubMed  Google Scholar 

  10. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  PubMed  Google Scholar 

  11. Caporusso EF, Fallat LM, Savoy-Moore R. Cryogenic neuroablation for the treatment of lower extremity neuromas. J Foot Ankle Surg. 2002;41:286–90. https://doi.org/10.1016/S1067-2516(02)80046-1.

    Article  PubMed  Google Scholar 

  12. Friedman T, Richman D, Adler R. Sonographically guided Cryoneurolysis: preliminary experience and clinical outcomes. J Ultrasound Med. 2012;31:2025–34. https://doi.org/10.7863/jum.2012.31.12.2025.

    Article  PubMed  Google Scholar 

  13. Kasparek M, Schneider W. Surgical treatment of Morton’s neuroma: clinical results after open excision. International Orthopaedics (SICOT). 2013;37:1857–61. https://doi.org/10.1007/s00264-013-2002-6.

    Article  Google Scholar 

  14. Deniz S, Purtuloglu T, Tekindur S, et al. Ultrasound-guided pulsed radio frequency treatment in Morton’s neuroma. J Am Podiatr Med Assoc. 2015;105:302–6. https://doi.org/10.7547/13-128.1.

    Article  PubMed  Google Scholar 

  15. Masala S, Cuzzolino A, Morini M, et al. Ultrasound-guided percutaneous radiofrequency for the treatment of Morton’s neuroma. Cardiovasc Intervent Radiol. 2018;41:137–44. https://doi.org/10.1007/s00270-017-1786-y.

    Article  PubMed  Google Scholar 

  16. Hughes RJ, Ali K, Jones H, et al. Treatment of Morton’s neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Am J Roentgenol. 2007;188:1535–9. https://doi.org/10.2214/AJR.06.1463.

    Article  Google Scholar 

  17. Bucknall V, Rutherford D, MacDonald D, et al. Outcomes following excision of Morton’s interdigital neuroma: a prospective study. The Bone & Joint Journal. 2016;98:1376–81. https://doi.org/10.1302/0301-620X.98B10.37610.

    Article  Google Scholar 

  18. Coughlin MJ, Pinsonneault T. Operative treatment of interdigital neuroma. A long-term follow-up study. J Bone Joint Surg Am. 2001;83:1321–8.

    Article  CAS  PubMed  Google Scholar 

  19. Faraj AA, Hosur A. The outcome after using two different approaches for excision of Morton’s neuroma. Chin Med J (Engl). 2010;123:2195–8.

    PubMed  Google Scholar 

  20. Giannini S, Bacchini P, Ceccarelli F, Vannini F. Interdigital neuroma: clinical examination and histopathologic results in 63 cases treated with excision. Foot Ankle Int. 2004;25:79–84. https://doi.org/10.1177/107110070402500208.

    Article  PubMed  Google Scholar 

  21. Nery C, Raduan F, Del Buono A, et al. Plantar approach for excision of a Morton neuroma: a long-term follow-up study. J Bone Joint Surg. 2012;94:654–8. https://doi.org/10.2106/JBJS.K.00122.

    Article  PubMed  Google Scholar 

  22. Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. International Orthopaedics (SICOT). 2010;34:511–5. https://doi.org/10.1007/s00264-009-0812-3.

    Article  Google Scholar 

Download references

Acknowledgements

None

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. From the Interventional Radiology Unit, Imaging Department (B.M., G.A., J.L.S., O.V., M.D.P., A.H.), From the Orthopedic Surgery Unit (S.R), and From the Anesthesiology Department (TG), American Hospital of Paris, 55 Boulevard du Chateau, 92200, Neuilly-sur-Seine, France

    Benjamin Moulin, Giorgio Angelopoulos, Jean Luc Sarrazin, Stephane Romano, Olivier Vignaux, Thierry Guenoun, Massimiliano Di Primio & Antoine Hakime

Authors
  1. Benjamin Moulin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giorgio Angelopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean Luc Sarrazin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephane Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivier Vignaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thierry Guenoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Massimiliano Di Primio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antoine Hakime
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Moulin.

Ethics declarations

Conflict of interest

The authors of this manuscript declare relationships with the following companies: B.M. disclosed no relevant relationships. G.A. disclosed no relevant relationships. J.L.S. activities related to the present article disclosed no relevant relationships. S.R. disclosed no relevant relationships. O.V. disclosed no relevant relationships. M.D.P. disclosed no relevant relationships. A.H. disclosed no relevant relationships.

Ethical Approval

Institutional Review Board approval was obtained.

Informed Consent

Only if the study is on human subjects: Written informed consent was obtained from all subjects (patients) in this study. Written informed consent was waived by the Institutional Review Board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moulin, B., Angelopoulos, G., Sarrazin, J.L. et al. Safety and Efficacy of Percutaneous Morton Neuroma Cryoneurolysis Under Ultrasound Guidance. Cardiovasc Intervent Radiol (2024). https://doi.org/10.1007/s00270-024-03669-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00270-024-03669-1

Keywords

Search

Navigation