CardioVascular and Interventional Radiology

, Volume 41, Issue 1, pp 137–144 | Cite as

Ultrasound-Guided Percutaneous Radiofrequency for the Treatment of Morton’s Neuroma

  • Salvatore Masala
  • Alessandro CuzzolinoEmail author
  • Marco Morini
  • Mario Raguso
  • Roberto Fiori
Clinical Investigation



Morton’s neuroma (MN) is a leading cause of disability. The purpose of this study was to investigate the effectiveness of radiofrequency (RF) in patients with chronic pain refractory to conservative therapies.


Between September 2012 and December 2016, RF was performed on 52 patients. A sterile RF needle probe (22G, 5-cm needle with 10-mm electrode active tip) was inserted between the toes into the intermetatarsal space at the center of the lesion. Potential complications of the intervention and post-procedure care were examined. All patients provided written, informed consent. All percutaneous procedures were performed with the NeuroTherm® NT1100 (Neurotherm Inc., M.) device and using ultrasound guidance (Philips IU22). Continuous RF was performed with one cycle of 90 s and with the probe tip maintaining a temperature of 85 °C (impedance 95–210 mΩ).


Mean VAS score before the procedures was 9.0 ± 0.6. A reduction of pain intensity was achieved after 1 week by RF (mean VAS scores 3.7 ± 0.9; p < 0.05), with a stabilization of the painful symptomatology in the following months and after 1 year of treatments (mean VAS scores 2.0 ± 0.4 after 12 months, p < 0.05). The FHSQ scores showed improved quality of life (QOL) in all patients at 6 months (p < 0.05) and 1 year (p < 0.05) of RF. No patients developed complications.


RF is a safe, efficient, and minimally invasive technique for the treatment of symptomatic MN.


Morton’s neuroma Foot pain Radiofrequency Chronic pain 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Thomson CE, Gibson JN, Martin D. Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev. 2004;3:CD003118.Google Scholar
  2. 2.
    Greenfield J, Rea J Jr, et al. Morton’s interdigital neuroma. Indications for treatment by local surgery. Clin Orthop Relat Res. 1984;185:142–4.Google Scholar
  3. 3.
    Zanetti M, Weishaupt D. MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol. 2005;9(3):175–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Torres-Claramunt R, Ginés A, Pidemunt G, Puig LI, De Zabala S. MRI and ultrasonography in Morton’s neuroma: diagnostic accuracy and correlation. Indian J Orthop. 2012;46(3):321–5.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Couglin MJ, Mann RA, Saltzmann CL. Surgery of the foot and ankle. 8th ed. Amsterdam: Mosby Elsevier; 2006. p. 614–34.Google Scholar
  6. 6.
    Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017. doi: 10.1016/j.spinee.2017.05.006.Google Scholar
  7. 7.
    Lee MJ, Kim S, Huh YM, Song HT, Lee SA, Lee JW, et al. Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol. 2007;8:148–55.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Zanetti M, Strehle JK, Kundert HP, Zollinger H, Hodler J. Morton neuroma: effect or MR imaging findings on diagnostic thinking and therapeutic decisions. Radiology. 1999;21:583–8.CrossRefGoogle Scholar
  9. 9.
    Sirera-Vercher MJ, Sàez-Zamora P, Sanz-Amaro MD. Traducción y adaptación transcultural al castellano y al valenciano del Foot Health Status Questionnaire. Rev Esp Cir Ortop Traumatol. 2010;54(4):211–9.Google Scholar
  10. 10.
    Bennett PJ, Patterson C, Wearing S, et al. Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc. 1998;88:419–28.CrossRefPubMedGoogle Scholar
  11. 11.
    Bennett PJ, Patterson C. The Foot Health Status Questionnaire (FHSQ): a new instrument for measuring outcomes of footcare. AJPM Orig Res. 1998;32(3):87–92.Google Scholar
  12. 12.
    Bennett GL, Graham CE, Mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int. 1995;16:760–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Lelievre J, Lelievre JF. Pathologie du Pied. Paris: Masson; 1981.Google Scholar
  14. 14.
    Gauthier G. Thomas Morton’s disease: a nerve entrapment syndrome. A new surgical technique. Clin Orthop. 1979;142:90–2.Google Scholar
  15. 15.
    Shapiro SL. Endoscopic decompression of the intermetatarsal nerve for Morton’s neuroma. Foot Ankle Clin. 2004;9:287–96.CrossRefGoogle Scholar
  16. 16.
    Vito BR, Talarico LM. A modified technique for Morton’s neuroma. J Am Podiatr Med Assoc. 2003;93:190–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Zelent ME, Kane RM, Neese DJ, Lockner WB. Minimally invasive Morton’s intermetatarsal neuroma decompression. Foot Ankle Int. 2007;28(2):263–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Sofka CM, Adler RS, Ciavarra GA, et al. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection: preliminary results. HSS J. 2007;3(1):44–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Rassmussen MR, Kitaoka HB, Pantzer GL. Nonoperative treatment of plantar interdigital neuroma with single corticosteroid injection. Clin Orthop Relat Res. 1996;326:188–93.CrossRefGoogle Scholar
  20. 20.
    Mann RA, Reynolds JC. Interdigital neuroma: a critical clinical analysis. Foot Ankle. 1983;3:238–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Greenfield J, Rea J Jr, Ilfeld FW. Morton’s interdigital neuroma: indications for treatment by local injection surgery. Clin Orthop Relat Res. 1984;185:142–4.Google Scholar
  22. 22.
    Hyer CF, Mehl LR, Block AJ, et al. Treatment of recalcitrant intermetatarsal neuroma with 4% sclerosing alcohol injection. J Foot Ankle Surg. 2005;44(4):287–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Mozena JD, Clifford JT. Efficacy of chemical neurolysis for the treatment of interdigital nerve compression of the foot: a retrospective study. J Am Podiatr Med Assoc. 2007;97(3):203–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Magnan B, Marangon A, Frigo A, et al. Local phenol injection in the treatment of interdigital neuritis of the foot (Morton’s neuroma). Chir Organi Mov. 2005;90:371–7.PubMedGoogle Scholar
  25. 25.
    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(6):1535–9.CrossRefGoogle Scholar
  26. 26.
    Cazzato PL, Garnon J, Ramamurthy N, Tsoumakidou G, Caudrelier J, Thenint M-A, Rao P, Koch G, Gangi A. Percutaneous MR-guided cryoablation of Morton’s neuroma: rationale and technical details after the first 20 patients. Cardiovasc Intervent Radiol. 2016. doi: 10.1007/s00270-016-1365-7.Google Scholar
  27. 27.
    Climent JM, Mondéjar-Gòmez F, Rodrìguez-Ruiz C, Dìaz-Llopis I, Gòmez-Gallego D, Martìn-Medina P. Treatment of Morton neuroma with botulinum toxin A: a pilot study. Clin Drug Investig. 2013;33:497–503.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Cione JA, Cozzarelli J, Mullin CJ. A retrospective study of radiofrequency thermal lesioning for the treatment of neuritis of the medial calcaneal nerve and its terminal branches in chronic heel pain. J Foot Ankle Surg. 2008;48:142–7.CrossRefGoogle Scholar
  29. 29.
    Finney W, Wiener S, Catanzariti F. Treatment of Morton’s neuroma using percutaneous electrocoagulation. J Am Podiatr Med Assoc. 1989;79:615–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Moore JL, Rosen R, Cohen J, Rosen B. Radiofrequency thermoneurolysis for the treatment of Morton’s neuroma. J Foot Ankle Surg. 2012;51:20–2.CrossRefPubMedGoogle Scholar
  31. 31.
    Chuter GS, Chua YP, Connell DA, Blackney MC. Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skeletal Radiol. 2013;42(1):107–11.CrossRefPubMedGoogle Scholar
  32. 32.
    Brooks D, Parr A, Bryceson W. Three cycles of radiofrequency ablation are more efficacious than two in the management of Morton’s neuroma. Foot Ankle Spec. 2017. doi: 10.1177/1938640017709905.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  1. 1.Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation TherapyUniversity of Rome “Tor Vergata”RomeItaly

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