title: Percutaneous needling of Morton's complex: a technical note.
abstract: BACKGROUND
  the Morton's complex, i.e. fibrotic mass enfolding the medial plantar nerve, the bursa and the interdigital transverse ligament in the web space, is a common cause of pain and functional disability. Conservative and operative treatments are investigated but currently the best approach to treat the Morton's complex is unknown.
  
  
  METHODS
  we describe a non-invasive, straight forward intervention consisting on multiple percutaneous punctures, shearing the fibrotic tissue in lateromedial and anteroposterior directions. The goal is to break up fibrosis occupying the intermetatarsal space thus releasing the affected nerve from the adjacent structures, there by stimulating tissue remodelling.
  
  
  RESULTS
  slow tissue remodelling occurs following sequential fibrosis cleavage through multiple needling. Needling of the intermetatarsal fibrosis is performed every eight weeks until pain resolution. Echographic changes are associated to pain reduction as measured by Visual Analogue Score (VAS).
  
  
  CONCLUSIONS
  we present an original idea that may improve Morton's management. Upcoming prospective clinical studies have to demonstrate the symptomatic benefits and the usefulness of this novel echographic intervention.
authors.affiliation: Department of Radiology, Interventional Echography, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Leire
authors.initials: L
authors.lastname: Atilano
authors.affiliation: Department of Radiology, Interventional Echography, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Martin
authors.affiliation: Department of Radiology, Interventional Echography, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Gotzon
authors.initials: G
authors.lastname: Iglesias
authors.affiliation: Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Andia
keywords: Morton neuroma; fibrosis; intermetatarsal ligament; needling; nerve; ultrasound