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Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This work compares the effectiveness of blind versus ultrasound (US)–guided injections for Morton neuroma (MN) up to 3 years of follow-up.

Methods

This is an evaluator-blinded randomised trial in which 33 patients with MN were injected by an experienced orthopaedic surgeon based on anatomical landmarks (blind injection, group 1) and 38 patients were injected by an experienced musculoskeletal radiologist under US guidance (group 2). Patients were assessed using the visual analogue scale and the Manchester Foot Pain and Disability index (MFPDI). Injections consisted of 1 ml of 2% mepivacaine and 40 mg triamcinolone acetonide in each web space with MN. Up to 4 injections were allowed during the first 3 months of follow-up. Follow-up was performed by phone calls and/or scheduled consultations at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1, 2 and 3 years. Statistical analysis was performed using unpaired Student’s t tests.

Results

No differences in age or clinical measures were found at presentation between group 1 (VAS, 8.5 ± 0.2; MFPDI, 40.9 ± 1.1) and group 2 (VAS, 8.4 ± 0.2; MFPDI, 39.8 ± 1.2). Improvement in VAS was superior in group 2 up to 3 years of follow-up (p < 0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p < 0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up.

Conclusion

Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN.

Key Points

• Ultrasound-guided corticosteroid injections in Morton neuroma provide long-term pain relief in more than 75% of patients.

• Ultrasound-guided injections in Morton neuroma led to greater long-term pain relief and less disability than blind injections up to 3 years of follow-up.

• The presence of an ipsilateral neuroma is associated with worse long-term disability score.

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Abbreviations

MFPDI:

Manchester Foot Pain and Disability Index

MN:

Morton neuroma

US:

Ultrasound

VAS:

Visual analogue scale

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Acknowledgements

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

Funding

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

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Authors and Affiliations

  1. Department of Radiology, Traumatology Hospital (University Hospital Virgen de las Nieves), C-Julio Verne 8, 7 B, 18003, Granada, Spain

    Fernando Ruiz Santiago, Pablo Tomás Muñoz, Antonio Jesús Láinez Ramos-Bossini & Alberto Martínez Martínez

  2. Department of Orthopedic Surgery, University Hospital Virgen de las Nieves, Granada, Spain

    Nicolás Prados Olleta

Authors
  1. Fernando Ruiz Santiago
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  2. Pablo Tomás Muñoz
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  3. Antonio Jesús Láinez Ramos-Bossini
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Corresponding author

Correspondence to Fernando Ruiz Santiago.

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Guarantor

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

One of the authors has significant statistical expertise.

Informed consent

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

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The short-term results (6 months) of 56 out of 75 current patients have been previously published in European Radiology.

Methodology

• prospective

• randomised controlled trial

• performed at one institution

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Santiago, F.R., Muñoz, P.T., Ramos-Bossini, A.J.L. et al. Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma. Eur Radiol 32, 8414–8422 (2022). https://doi.org/10.1007/s00330-022-08932-y

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