Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma.
BACKGROUND
The purpose of this study was to evaluate the efficacy of corticosteroid injection and determine the duration of symptom-free period after treatment with a single ultrasound-guided injection for a painful Morton's neuroma.


METHODS
From May 2002 to November 2003, 35 consecutive patients (7 males, 28 females) (mean age, 54; age range, 29 to 77 years) underwent a single ultrasound guided corticosteroid injection. Thirty-nine injections were performed as 4 patients had bilateral Morton's neuromas. The injection of 1.0 cc Celestone Chronodose (5.7 mg/ml) with 0.5 cc of 1% lidocaine was performed into the symptomatic intermetatarsal web-space. The efficacy of the injection was determined by the Johnson grading scale, and modified lower extremity functional scale.


RESULTS
On the Johnson scale, 15 of 39 (38%) neuromas showed complete satisfaction 9 months after treatment and 11 of 39 (28%) were satisfied with minor reservations. A total of 26 of 39 (66%) neuromas had a positive outcome 9 months after the injection. On the functional daily activity (FDA) scale, 20 of 39 (51%) neuromas showed no difficulty and 4 of 39 (10%) indicated minor difficulties, which was considered a positive outcome 9 months after injection. Complete pain relief was achieved in 11 of 39 (28%) neuromas 9 months after treatment. Twelve of 39 (31%) neuromas did not respond to conservative treatment and required surgery. The results of treatment suggested improvement in efficacy if injection was used early. The size of the lesion measured on ultrasound showed no correlation with pain relief after injection.


CONCLUSIONS
A single corticosteroid injection can offer short-term pain relief in the conservative management of Morton's neuroma.
University of Sydney Sports Clinic, Western Ave & Physics Rd, University of Sydney, NSW 2006, Australia. majam@amsc.com.au
Maja
M
Markovic
Ken
K
Crichton
John W
JW
Read
Peter
P
Lam
Henry Kim
HK
Slater
D000328:Adult; D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005545:Forefoot, Human / Q000294:innervation*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
D005938:Glucocorticoids; C018230:betamethasone acetate phosphate; D001623:Betamethasone