title: Methylprednisolone injections for the treatment of Morton neuroma: a patient-blinded randomized trial.
abstract: BACKGROUND
  Morton neuroma is a common cause of neuralgia affecting the web spaces of the toes. Corticosteroid injections are commonly administered as a first-line therapy, but the evidence for their effectiveness is weak. Our primary research aim was to determine whether corticosteroid injection is an effective treatment for Morton neuroma compared with an anesthetic injection as a placebo control.
  
  
  METHODS
  We performed a pragmatic, patient-blinded randomized trial set within hospital orthopaedic outpatient clinics in Edinburgh, United Kingdom. One hundred and thirty-one participants with Morton neuroma (mean age, fifty-three years; 111 [85%] female) were randomized to receive either corticosteroid and anesthetic (1 mL methylprednisolone [40 mg] and 1 mL 2% lignocaine) or anesthetic alone (2 mL 1% lignocaine). An ultrasonographic image was obtained before treatment, and injections were performed with the needle placed under ultrasonographic guidance. The primary outcome was the difference in patient global assessment of foot health between the two groups at three months after injection. This was measured with use of a 100-unit visual analog scale (VAS) anchored by "best imaginable health state" and "worst imaginable health state."
  
  
  RESULTS
  Compared with the control group, global assessment of foot health in the corticosteroid group was significantly better at three months (mean difference, 14.1 scale points [95% confidence interval, 5.5 to 22.8 points]; p = 0.002). The difference between the groups was also significant at one month. Significant and nonsignificant improvements associated with the corticosteroid injection were observed for measures of pain, function, and patient global assessment of general health at one and three months after injection. The size of the neuroma as determined by ultrasonography did not significantly influence the treatment effect.
  
  
  CONCLUSIONS
  Corticosteroid injections for Morton neuroma can be of symptomatic benefit for at least three months.
authors: Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh EH21 6UU, Scotland. cthomson@qmu.ac.uk
authors: Colin E
authors: CE
authors: Thomson
authors: Ian
authors: I
authors: Beggs
authors: Denis J
authors: DJ
authors: Martin
authors: Diane
authors: D
authors: McMillan
authors: Rhiannon Tudor
authors: RT
authors: Edwards
authors: Daphne
authors: D
authors: Russell
authors: Seow Tien
authors: ST
authors: Yeo
authors: Ian T
authors: IT
authors: Russell
authors: J N Alastair
authors: JN
authors: Gibson
mesh_terms: D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D009463:Neuroma / Q000150:complications / Q000188:drug therapy*; D016037:Single-Blind Method
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone