title: Treatment of Morton neuroma with botulinum toxin A: a pilot study.
abstract: OBJECTIVE
  Morton neuroma is a common cause of metatarsalgia of neuropathic origin. Systematic reviews suggest that insufficient studies have been performed on the efficacy of the different treatments available. OnabotulinumtoxinA has shown a degree of usefulness in other conditions associated with neuropathic pain. The aim of this study was to investigate the therapeutic potential of onabotulinumtoxinA in Morton neuroma.
  
  
  METHODS
  We present an open-label, pilot study with 17 consecutive patients with Morton neuroma and pain of more than 3 months' duration that had not responded to conservative treatment with physical measures or corticosteroid injection. Patients received one onabotulinumtoxinA injection in the area of the neuroma. The main outcome measure was the variation in the pain on walking evaluated using a visual analogue scale (VAS) before treatment and at 1 and 3 months after treatment. The secondary outcome was the change in foot function, which was assessed using the Foot Health Status Questionnaire.
  
  
  RESULTS
  In the overall group, the mean initial VAS score on walking was 7. This mean score had fallen to 4.8 at 1 month after treatment and to 3.7 at 3 months. Twelve patients (70.6 %) reported an improvement in their pain and five patients (29.4 %) reported no change; exacerbation of the pain did not occur in any patient. Improvements were also observed in two of the dimensions of the Foot Health Status Questionnaire: foot pain, which improved from a mean of 38.88 before treatment to 57 at 3 months, and foot function, which improved from a mean of 42.27 before treatment to 59.9 at 3 months. Clinical variables including age, sex, site and size of the lesion, standing activity, weekly duration of walking, footwear, foot type and footprint had no influence on the outcome. No adverse effects were reported.
  
  
  CONCLUSIONS
  In this pilot study, injection with onabotulinumtoxinA was shown to be of possible usefulness to relieve the pain and improve function in Morton neuroma. This finding opens the door to further clinical research.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hospital General Universitario, Maestro Alonso 109, 03010, Alicante, Spain. jclimentba@gmail.com
authors.forename: José M
authors.initials: JM
authors.lastname: Climent
authors.forename: Francisco
authors.initials: F
authors.lastname: Mondéjar-Gómez
authors.forename: Carmen
authors.initials: C
authors.lastname: Rodríguez-Ruiz
authors.forename: Ismael
authors.initials: I
authors.lastname: Díaz-Llopis
authors.forename: Diego
authors.initials: D
authors.lastname: Gómez-Gallego
authors.forename: Patricia
authors.initials: P
authors.lastname: Martín-Medina
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000175:diagnosis / Q000188:drug therapy*; D010865:Pilot Projects
chemical_list: D019274:Botulinum Toxins, Type A