European Radiology

, Volume 29, Issue 2, pp 620–627 | Cite as

Short term comparison between blind and ultrasound guided injection in morton neuroma

  • Fernando Ruiz SantiagoEmail author
  • Nicolás Prados Olleta
  • Pablo Tomás Muñoz
  • Luis Guzmán Álvarez
  • Alberto Martínez Martínez



The aim of this work is to compare the effectiveness of blind and ultrasound-guided injection for Morton’s neuroma (MN) to determine which is more appropriate as the initial procedure in conservative treatment.


This is an evaluator-blinded randomised trial. Of the 56 included patients, 27 were assigned to the blind group (A) and 29 to the ultrasound-guided group (B). Injection includes 1 ml of 2% mepivacaine and 40 mg of triamcinolone in each web space with MN. The included patients were assessed clinically by VAS score and the Manchester Foot Pain and Disability Score (MFPDS). The follow-up was performed at 15 days, 1 month, 45 days, 2 months, 3 months and 6 months after the initial injection.


No differences in age or clinical measurements were found at presentation between group A and group B. At the follow-up, the ultrasound-guided group showed greater symptomatic relief at several stages of the follow-up: 45 days (VAS 3.0 ± 0.5 versus 5.5 ± 0.5, p = 0.001; MFPDS: 32.2 ± 1.8 versus 38.8 ± 2.0, p = 0.018), 2 months (VAS: 3.1 ± 0.5 versus 5.6 ± 0.5, p = 0.002; MFPDS: 31.5 ± 1.9 versus 38.5 ± 2.1, p = 0.020) and 3 months (VAS: 3.1 ± 0.4 versus 5.2 ± 0.6, p = 0.010; MFPDS: 31.2 ± 1.9 versus 37.7 ± 2.4, p = 0.047).


Injection of MN under ultrasound guidance provides a statistically significant improvement at some stages of the follow-up (45 days, 2 and 3 months), compared with blind injection.

Key Points

• Ultrasound-guided steroid injections in Morton’s neuroma provide short-term pain relief to over 60% of the patients.

• Ultrasound-guided injections in Morton’s neuroma lead to a higher percentage of short-term pain relief than blind injections.

• Ultrasound-guided injections in Morton’s neuroma lead to a lower percentage of skin side effects than blind injections.


Morton neuroma Ultrasonography interventional Metatarsalgia 



Manchester Foot Pain and Disability Score


Morton’s neuroma




Visual analogue scale



Thanks to Loreto Vasquez for her kind collaboration reviewing the English grammar of the article and to Manuela Exposito Ruiz for her statistical support.


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

Compliance with ethical standards


The scientific guarantor of this publication is Fernando Ruiz Santiago

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Manuela Exposito Ruiz, from FIBAO, Hospital Virgen de las Nieves, kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• randomised controlled trial

• performed at one institution

Supplementary material

330_2018_5670_MOESM1_ESM.mp4 (18.4 mb)
ESM 1 (MP4 18874 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Traumatology Hospital (University Hospital Virgen de las Nieves)GranadaSpain
  2. 2.Department of Orthopedic SurgeryUniversity Hospital Virgen de las NievesGranadaSpain

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