Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous alcohol injection under sonographic guidance in Morton’s neuroma: follow-up in 220 treated lesions

  • MUSCULOSKELETAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy and safety of percutaneous treatment of Civinini–Morton’s syndrome due to solitary Morton’s neuroma and analyze the effect of clinico-demographic factors on outcome.

Materials and methods

Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15–24).

Results

We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients.

Conclusions

Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Volpe A, Tognon S, Fassina A (1998) Morton’s syndrome: surgical strategies according to the digital nerve pathology. Foot Ankle Surg 4(3):129–137. doi:10.1046/j.1460-9584.1998.00096.x

    Article  Google Scholar 

  2. Wu KK (1996) Morton’s interdigital neuroma: a clinical review of its etiology, treatment, and results. J Foot Ankle Surg 35(2):112–119. doi:10.1016/S1067-2516(96)80027-5

    Article  CAS  PubMed  Google Scholar 

  3. Pace A, Scammell B, Dhar S (2010) The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop 34(4):511–515. doi:10.1007/s00264-009-0812-3

    Article  PubMed  Google Scholar 

  4. Hassouna H, Singh D (2005) Morton’s metatarsalgia: pathogenesis, aetiology and current management. Acta Orthop Belg 646–655

  5. Stecco C, Fantoni I, Macchi V, Del Borrello M, Porzionato A, Biz C, De Caro R (2015) The role of fasciae in Civinini-Morton’s syndrome. J Anat 227(5):654–664. doi:10.1111/joa.12371

    Article  CAS  PubMed  Google Scholar 

  6. Nissen KI (1948) Plantar digital neuritis: Morton’s metatarsalgia. J Bone Jt Surg Am 31:84–94

    Google Scholar 

  7. Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52(1):77–92. doi:10.1016/j.neuron.2006.09.021

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Baron R (2009) Neuropathic pain: a clinical perspective. Handb Expl Pharmacol 194:3–30. doi:10.1007/978-3-540-79090-7_1

    Article  CAS  Google Scholar 

  9. Herr K (2004) Neuropathic pain: a guide to comprehensive assessment. Pain Manag Nurs Dec 5(4 Suppl 1):9–18

    Article  Google Scholar 

  10. Koltzenburg M (2000) Neural mechanisms of cutaneous nociceptive pain. Clin J Pain Sep 16(3):131–138

    Article  Google Scholar 

  11. Thomas JL, Blitch EL, Chaney DM, Dinucci KA, Eickmeier K, Rubin LG et al (2009) Diagnosis and treatment of forefoot disorders. Section 3. Morton’s intermetatarsal neuroma. J Foot Ankle Surg 48(2):251–256. doi:10.1053/j.jfas.2008.12.005

    Article  PubMed  Google Scholar 

  12. Pastides P, El-Sallakh S, Charalambides C (2012) Morton’s neuroma: a clinical versus radiological diagnosis. Foot Ankle Surg 18(1):22–24. doi:10.1016/j.fas.2011.01.007

    Article  PubMed  Google Scholar 

  13. Perini L, Del Borrello M, Cipriano R, Cavallo A, Volpe A (2006) Dynamic sonography of the forefoot in Morton’s syndrome: correlation with magnetic resonance and surgery. Radiol Med 111(7):897–905. doi:10.1007/s11547-006-0088-2

    Article  CAS  PubMed  Google Scholar 

  14. Lee M-J, Kim S, Huh Y-M, Song H-T, Lee S-A, Lee JW, Suh J-S (2007) Morton neuroma: evaluated with ultrasonography and MR imaging. Korean J Radiol 8:148–155

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Torres-Claramunt R, Ginés A (2012) MRI and ultrasonography in Morton’s neuroma: diagnostic accuracy and correlation. Indian J Orthop 46(3):321–325

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Fazal M, Khan I, Thomas C (2012) Ultrasonography and magnetic resonance imaging in the diagnosis of Morton’s neuroma. J Am Podiat Med Assoc 102(3):184–186

    Article  Google Scholar 

  17. Zanetti M, Strehle JK, Zollinger H, Hodler J (1997) Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology 203(2):516–520. doi:10.1148/radiology.203.2.9114115

    Article  CAS  PubMed  Google Scholar 

  18. Zanetti M, Weishaupt D (2005) MR imaging of the forefoot: Morton neuroma and differential diagnoses. Semin Musculoskelet Radiol 9(3):175–186

    Article  PubMed  Google Scholar 

  19. Schreiber K, Khodaee M, Sourav Poddar M (2011) What is the best way to treat Morton’s neuroma? J Fam Pract 60(3):157–168

    PubMed  Google Scholar 

  20. Markovic M, Crichton K, Read J, Lam P, Slater H (2008) Effectiveness of ultrasound guided corticosteroid injection in the treatment of Morton’s neuroma. Foot Ankle Int 29:483–487

    Article  PubMed  Google Scholar 

  21. Rasmussen M, Kitaoka H, Patzer G (1996) Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clin Orthop Relat Res 326:188–193

    Article  PubMed  Google Scholar 

  22. Makki D, Haddad BZ, Mahmood Z, Shahid MS, Pathak S, Garnham I (2012) Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot Ankle Int 33(9):722–726. doi:10.3113/FAI.2012.0722

    Article  PubMed  Google Scholar 

  23. Magnan B, Marangon A, Frigo A, Bartolozzi P (2005) Local phenol injection in the treatment of interdigital neuritis of the foot (Morton’s neuroma). Chir Organi Mov 90(4):371–377

    CAS  PubMed  Google Scholar 

  24. Hughes RJ, Ali K, Jones H, Kendall S, Connell DA (2007) Treatment of Morton’s neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR 188(6):1535–1539. doi:10.2214/AJR.06.1463

    Article  PubMed  Google Scholar 

  25. Dockery GL (1999) The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. J Foot Ankle Surg 38(6):403–408. doi:10.1016/S1067-2516(99)80040-4

    Article  CAS  PubMed  Google Scholar 

  26. Musson R, Sawhney J, Lamb L, Wilkinson A, Obaid H (2012) Ultrasound guided alcohol ablation of Morton’s neuroma. Foot Ankle Int 33(3):196–201

    Article  PubMed  Google Scholar 

  27. Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G (2004) Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol 14(3):514–518. doi:10.1007/s00330-003-2057-7

    Article  PubMed  Google Scholar 

  28. Espinosa N, Seybold JD, Jankauskas L, Erschbamer M (2011) Alcohol sclerosing therapy is not an effective treatment for interdigital neuroma. Foot Ankle Int 32(06):576–580. doi:10.3113/FAI.2011.0576

    Article  PubMed  Google Scholar 

  29. Gurdezi S, White T, Ramesh P (2013) Alcohol injection for Morton’s neuroma: a five-year follow-up. Foot Ankle Int 34(8):1064–1067. doi:10.1177/1071100713489555

    Article  PubMed  Google Scholar 

  30. Chuter GSJ, Chua YP, Connell DA, Blackney MC (2013) Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma. Skelet Radiol 42(1):107–111. doi:10.1007/s00256-012-1527-x

    Article  Google Scholar 

  31. Genon M, Chin T, Bedi H, Blackney MC (2010) Radio-frequency ablation for the treatment of Morton’s neuroma. ANZ J Surg 80(9):583–585

    Article  PubMed  Google Scholar 

  32. Moore JL, Rosen R, Cohen J, Rosen B (2012) Radiofrequency thermoneurolysis for the treatment of Morton’s neuroma. J Foot Ankle Surg 51(1):20–22. doi:10.1053/j.jfas.2011.10.007

    Article  PubMed  Google Scholar 

  33. Jerosch J, Schunck J, Khoja A (2006) Results after Morton’s neuroma resection via plantar approach. Foot Ankle Surg 12(3):133–137. doi:10.1016/j.fas.2006.03.004

    Article  Google Scholar 

  34. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS Pain), numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF). Arthritis Care Res. 63(Suppl 11):S240–S252. doi:10.1002/acr.20543

    Article  Google Scholar 

  35. Akermark C, Saartok T, Zuber Z (2008) A prospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal neuromas (Morton’s neuroma). Foot Ankle Surg 14(2):67–73. doi:10.1016/j.fas.2007.10.004

    Article  PubMed  Google Scholar 

  36. Thomson CE, Gibson JN, Martin D (2004) Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev (3):CD003118. doi:10.1002/14651858.CD003118.pub2

  37. Hyer CF, Mehl LR, Block AJ, Vancourt RB (2005) Treatment of recalcitrant intermetatarsal neuroma with 4% sclerosing alcohol injection: a pilot study. J Foot Ankle Surg 44(4):287–291. doi:10.1053/j.jfas.2005.04.010

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy

    Luciano Perini, Davide Varotto, Andrea Valcarenghi, Andrea Postorino & Antonio Volpe

  2. Department of Gastroenterology, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy

    Claudia Perini

  3. Department of Neurological and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy

    Matteo Tagliapietra

Authors
  1. Luciano Perini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudia Perini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matteo Tagliapietra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Davide Varotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Valcarenghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Postorino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Volpe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luciano Perini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed were in accordance with the ethical standards of the institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal consent from the ethics committee is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perini, L., Perini, C., Tagliapietra, M. et al. Percutaneous alcohol injection under sonographic guidance in Morton’s neuroma: follow-up in 220 treated lesions. Radiol med 121, 597–604 (2016). https://doi.org/10.1007/s11547-016-0622-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-016-0622-9

Keywords

Search

Navigation