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Treating Morton’s neuroma by injection, neurolysis, or neurectomy: a systematic review and meta-analysis of pain and satisfaction outcomes

  • Review Article - Peripheral Nerves
  • Published:
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Abstract

Background

Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton’s neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton’s neuroma with respect to these outcomes.

Methods

Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions.

Results

A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton’s neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23–64%) was significantly lower than neurolysis (68%; 95% CI, 51–84%) and neurectomy (74%; 95% CI, 66–82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21–50%) was significantly lower than neurolysis (63%; 95% CI, 50–74%) and neurectomy (57%; 95% CI, 47–67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9–23%) versus neurolysis (2%; 95% CI, 0–4%) or neurectomy (5%; 95% CI, 3–7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30).

Conclusions

Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton’s neuroma should incorporate these findings to better form and meet the expectations of patients.

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Authors and Affiliations

  1. Department of Neurological Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Victor M. Lu, Ross C. Puffer, Megan C. Everson, Hannah E. Gilder & Robert J. Spinner

  2. Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA

    S. Shelby Burks

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Correspondence to Robert J. Spinner.

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Lu, V.M., Puffer, R.C., Everson, M.C. et al. Treating Morton’s neuroma by injection, neurolysis, or neurectomy: a systematic review and meta-analysis of pain and satisfaction outcomes. Acta Neurochir 163, 531–543 (2021). https://doi.org/10.1007/s00701-020-04241-9

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