Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton's) neuroma.
OBJECTIVE
To identify the benefits of ultrasound-guided radiofrequency ablation of Morton's neuroma as an alternative to surgical excision.


METHODS
We studied a consecutive cohort of surgical candidates for Morton's neurectomy who we referred, instead, for radiofrequency ablation (RFA). Under local anaesthetic, RFA was performed under ultrasound guidance, by a single radiologist. This out-patient procedure was repeated after 4 weeks if necessary. We followed patients for a minimum of 6 months to assess their change in visual analogue pain scores (VAS), symptom improvement, complications and progression to surgical excision.


RESULTS
Thirty feet in 25 patients were studied. There were 4 men and 21 women with an average age of 55 years (range 33-73 years). All had tried previous methods of conservative management. Forty percent presented with 2nd space neuromas and 60% with 3rd space ones. The average number of treatment sessions was 1.6 (range 1-3, mode 1). Prior to treatment, all patients had pain on activity (VAS average: 6.0, range 3-9). Post-treatment there was a statistically significant reduction in pain scores (post-RFA VAS average: 1.7, range 0-8, p < 0.001). The average overall symptom improvement was 76%. There was one minor complication of temporary nerve irritation. Three neuromas (10%) have progressed to surgical excision; 1 patient has ongoing, unchanged pain with no obvious cause. At 6 months, 26 out of 30 feet had a satisfactory outcome.


CONCLUSIONS
Ultrasound-guided RFA has successfully alleviated patients' symptoms of Morton's neuroma in >85% of cases. Only 10% have proceeded to surgical excision in the short term.
Department of Orthopaedics, Darlington Memorial Hospital, Darlington, County Durham, DL3 6HX, UK. gchuter@hotmail.com
Graham S J
GS
Chuter
Yeok Pin
YP
Chua
David A
DA
Connell
Mark C
MC
Blackney
D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional