Treatment of Morton’s neuroma with focused shock waves Comparison between shock waves and surgery
Clinical Study | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 13-16 | Bernard Meyer , Daniel Moya
DOI: 10.13107/jrs.2022.v02.i02.055
Author: Bernard Meyer [1], Daniel Moya [2]
[1] Orthopaedic Surgeon. Moinhos de Vento Hospital, Porto Alegre, RS, Brasil,
[2] Orthopaedic Surgeon. Hospital Británico de Buenos Aires, Argentina.
Address of Correspondence
Dr. Bernard Meyer, MD,
Orthopaedic Surgeon. Moinhos de Vento Hospital, Porto Alegre, RS, Brasil.
E-mail: bernardfabiomeyer@gmail.com
Abstract
Various treatments have been described for Morton’s neuroma. We compare the results of shock wave treatment with surgical neurectomy in a prospective series of 32 cases randomly assigned. In the group of patients treated with focused waves (17 cases), the percentage of good results was 70.6%, while in the operated patients (15 cases) it amounted to 93.2%. Poor results were found in 29.4% in shockwave group and 6.8 % in surgical group. Focused shock waves have a high, but lower success rate than surgery in the treatment of Morton’s neuromas. Nevertheless, due to their non-invasiveness and low chance of complications, they can be considered an option prior to minimally invasive and surgical techniques.
Keywords: Morton neuroma, shockwaves, neurectomy.
References:
1. Bhatia M, Thomson L. Morton’s neuroma – Current concepts review. J Clin Orthop Trauma. 2020 May-Jun;11(3):406-409. doi: 10.1016/j.jcot.2020.03.024. Epub 2020 Apr 10. PMID: 32405199; PMCID: PMC7211826.
2. Bennett G.L., Graham C.E., Mauldin D.M. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int. 1995;16(12):760–763. doi: 10.1177/107110079501601204.
3. Valisena S, Petri GJ, Ferrero A. Treatment of Morton’s neuroma: A systematic review. Foot Ankle Surg. 2018 Aug;24(4):271-281. doi: 10.1016/j.fas.2017.03.010. Epub 2017 Apr 5. PMID: 29409240.
4. Matthews BG, Hurn SE, Harding MP, Henry RA, Ware RS. The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton’s neuroma): a systematic review and meta-analysis. J Foot Ankle Res. 2019 Feb 13;12:12. doi: 10.1186/s13047-019-0320-7. PMID: 30809275; PMCID: PMC6375221.
5. Thomson L, Aujla RS, Divall P, Bhatia M. Non-surgical treatments for Morton’s neuroma: A systematic review. Foot Ankle Surg. 2020 Oct;26(7):736-743. doi: 10.1016/j.fas.2019.09.009. Epub 2019 Nov 2. PMID: 31718949.
6. Markovic M, Crichton K, Read JW, Lam P, Slater HK. Effectiveness of Ultrasound-Guided Corticosteroid Injection in the Treatment of Morton’s Neuroma. Foot & Ankle International. 2008;29(5):483-487. doi:10.3113/FAI-2008-0483.
7. Lizano-Díez X, Ginés-Cespedosa A, Alentorn-Geli E, Pérez-Prieto D, González-Lucena G, Gamba C. et al.: Corticosteroid injection for the treatment of Morton’s neuroma: a prospective, double-blinded, randomized, placebo-controlled trial. Foot Ankle Int 2017; 38: 944–951.
8. Klontzas ME, Koltsakis E, Kakkos GA, Karantanas AH. Ultrasound-guided treatment of Morton’s neuroma. J Ultrason. 2021 Jun 7;21(85):e134-e138. doi: 10.15557/JoU.2021.0022. Epub 2021 Jun 18. PMID: 34258038; PMCID: PMC8264811.
9. Sofka CM, Adler RS, Ciavarra GA, Pavlov H. Ultrasound-guided interdigital neuroma injections: short-term clinical outcomes after a single percutaneous injection–preliminary results. HSS J. 2007 Feb;3(1):44-9. doi: 10.1007/s11420-006-9029-9. PMID: 18751769; PMCID: PMC2504098.
10. Diebold PF, Delagoutte JP. La neurolyse vraie dans le traitement du névrome de Morton [True neurolysis in the treatment of Morton’s neuroma]. Acta Orthop Belg. 1989;55(3):467-71. French. PMID: 2603689.
11. Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G. Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol. 2004 Mar;14(3):514-8. doi: 10.1007/s00330-003-2057-7. Epub 2003 Oct 3. PMID: 14531002.
12. Gurdezi S., White T., Ramesh P. Alcohol injection for Morton’s neuroma: a five-year follow-up. Foot Ankle Int. 2013 doi: 10.1177/1071100713489555.
13. Deniz S, Purtuloglu T, Tekindur S, Cansız KH, Yetim M, Kılıckaya O, Senkal S, Bilgic S, Atim A, Kurt E. Ultrasound-guided pulsed radio frequency treatment in Morton’s neuroma. J Am Podiatr Med Assoc. 2015 Jul;105(4):302-6. doi: 10.7547/13-128.1. Epub 2015 May 6. PMID: 25945935.
14. Shah R, Ahmad M, Hanu-Cernat D, Choudhary S. Ultrasound-guided radiofrequency ablation for treatment of Morton’s neuroma: initial experience. Clin Radiol. 2019 Oct;74(10):815.e9-815.e13. doi: 10.1016/j.crad.2019.07.002. Epub 2019 Aug 10. PMID: 31409448.
15. Lee K, Hwang IY, Ryu CH, Lee JW, Kang SW. Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma. Foot Ankle Int. 2018 Feb;39(2):201-204. doi: 10.1177/1071100717739578. Epub 2017 Nov 20. PMID: 29153007.
16. Pace A, Scammell B, Dhar S. The outcome of Morton’s neurectomy in the treatment of metatarsalgia. Int Orthop. 2010 Apr;34(4):511-5. doi: 10.1007/s00264-009-0812-3. Epub 2009 May 30. PMID: 19484237; PMCID: PMC2903131.
17. Kasparek M, Schneider W. Surgical treatment of Morton’s neuroma: clinical results after open excision. Int Orthop. 2013 Sep;37(9):1857-61. doi: 10.1007/s00264-013-2002-6. Epub 2013 Jul 13. PMID: 23851648; PMCID: PMC3764278.
18. Xu W, Zhang N, Li Z, Wang Y, Li X, Wang Y, Si H, Hu Y. Plantar and dorsal approaches for excision of morton’s neuroma: a comparison study. BMC Musculoskelet Disord. 2022 Oct 6;23(1):898. doi: 10.1186/s12891-022-05858-w. PMID: 36203146; PMCID: PMC9535891.
19. Akermark C, Saartok T, Zuber Z. Aprospective 2-year follow-up study of plantar incisions in the treatment of primary intermetatarsal
neuromas (Morton’s neuroma) Foot Ankle Surg. 2008;14:67–73. doi: 10.1016/j.fas.2007.10.004.
20. Akermark C, Crone H, Skoog A, Weidenhielm L. A prospective randomized controlled trial of plantar versus dorsal incisions for operative treatment of primary Morton’s neuroma. Foot Ankle Int. 2013 Sep;34(9):1198-204. doi: 10.1177/1071100713484300. Epub 2013 Apr 5. PMID: 23564425.
21. Sato G, Ferreira GF, Sevilla D, Oliveira CN, Lewis TL, Dinato MCME, Pereira Filho MV. Treatment of Morton’s neuroma with minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) and percutaneous release of the deep transverse metatarsal ligament (DTML): a case series with minimum two-year follow-up. Int Orthop. 2022 Dec;46(12):2829-2835. doi: 10.1007/s00264-022-05557-0. Epub 2022 Aug 29. PMID: 36031662.
22. Bauer T, Gaumetou E, Klouche S, Hardy P, Maffulli N. Metatarsalgia and Morton’s Disease: Comparison of Outcomes Between Open Procedure and Neurectomy Versus Percutaneous Metatarsal Osteotomies and Ligament Release With a Minimum of 2 Years of Follow-Up. J Foot Ankle Surg. 2015 May-Jun;54(3):373-7. doi: 10.1053/j.jfas.2014.08.009. Epub 2014 Dec 4. PMID: 25481724.
23. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am. 2018 Feb 7;100(3):251-263. doi: 10.2106/JBJS.17.00661. PMID: 29406349.
24. Seok H, Kim SH, Lee SY, Park SW. Extracorporeal Shockwave Therapy in Patients with Morton’s Neuroma A Randomized, Placebo-Controlled Trial. J Am Podiatr Med Assoc. 2016 Mar;106(2):93-9. doi: 10.7547/14-131. PMID: 27031544.
25. Fridman R, Cain JD, Weil L Jr. Extracorporeal shockwave therapy for interdigital neuroma: a randomized, placebo-controlled, double-blind trial. J Am Podiatr Med Assoc. 2009 May-Jun;99(3):191-3. doi: 10.7547/0980191. PMID: 19448168.
26. Johnson, JE; Johnson, KA; Unni KK: Persistent pain after excision of interdigital neuroma. J. Bone Joint Surg. 70A:651 – 657,1988.
27. Biz C, Bonvicini B, Sciarretta G, Pendin M, Cecchetto G, Ruggieri P. Digital Ischemia after Ultrasound-Guided Alcohol Injection for Morton’s Syndrome: Case Report and Review of the Literature. J Clin Med. 2022 Oct 24;11(21):6263. doi: 10.3390/jcm11216263. PMID: 36362491; PMCID: PMC9657702.
28. Interventional procedure overview of radiofrequency ablation for symptomatic interdigital (Morton’s) neuroma. National institute for health and care excellence (NICE). https://www.nice.org.uk/guidance/ipg539/documents/radiofreque ncy-ablation-for-symptomatic-interdigital-mortons-neuromaoverview2#:~:text=ablation%20for%20symptomatic%20interdigital%20(Morton’s)%20neurom a,Interdigital%20(Morton’s)%20neuroma&text=In%20this%20procedure%2C%20a%20thin,nerve%20with%20radiofrequency%20heat20energy. Last accessed July 2022.
29. Womack JW, Richardson DR, Murphy GA, Richardson EG, Ishikawa SN. Long-term evaluation of interdigital Neuroma treated by surgical excision. Foot Ankle Int. 2008;29:574–577. doi: 10.3113/FAI.2008.0574.
30. Lorbach O, Kusma M, Pape D, Kohn D, Dienst M. Influence of deposit stage and failed ESWT on the surgical results of arthroscopic treatment of calcifying tendonitis of the shoulder, Knee Surg. Sports Traumatol. Arthrosc. 16 (5) (2008) 516e-521, http://dx.doi.org/10.1007/s00167-008-0507-0.
How to Cite this article: Meyer B, Moya D | Treatment of Morton’s neuroma with focused shock waves Comparison between shock waves and surgery. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 13-16. |