Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection--preliminary results.
OBJECTIVE
To describe the procedure of ultrasound-guided Morton's neuroma and recurrent stump neuroma injections and early clinical outcomes after a single injection.


METHODS
Retrospective review of 44 percutaneous ultrasound-guided neuroma injections in 24 patients who had completed clinical outcomes questionnaires. A 10-point pain scale [scale of 1 (no pain) to 10 (severe pain)] in a 7-day pain log format was distributed to patients at the time percutaneous neuroma injection was performed.


RESULTS
Neuromas were clearly visualized with sonography as hypoechoic nodules and were distinguishable from other causes of forefoot pain, such as metatarsophalangeal joint synovitis and intermetatarsal bursae. The sizes of the neuromas injected ranged between 4 and 19 mm. Postinjection, all neuromas displayed increased echogenicity and/or the appearance of fluid surrounding it, confirming localization of the therapeutic mixture. We arbitrarily subdivided the pain ratings into symptomatic (greater than 4) and asymptomatic (less than or equal to 4) for statistical analysis. Average pain level pre injection was 5.2 and average pain level was 3.7 at 7 days post single injection, with 62% of the initially symptomatic patients asymptomatic on day 7 (p < 0.000001). Overall, 76% of the total number of neuromas injected once were asymptomatic on day 7.


CONCLUSIONS
Ultrasound can be used to accurately target Morton's neuromas and, therefore, appropriately direct therapeutic interventions, with good short-term clinical results.
Sofka
Carolyn M
CM
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, USA. sofkac@hss.edu
Adler
Ronald S
RS
Ciavarra
Gina A
GA
Pavlov
Helene
H