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.


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.


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). 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,


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.

[Abstract Text HTML] [Full Text PDF] [XML]

Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?

Case Report | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 21-23 | Lauro Schledorn de Camargo , Ricardo Kobayashi
DOI: 10.13107/jrs.2022.v02.i02.59

Author: Lauro Schledorn de Camargo [1], Ricardo Kobayashi [2]

[1] Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil,
[2] Pain Center, Department of Neurology, University of São Paulo, Brazil.

Address of Correspondence
Dr. Lauro Schledorn de Camargo, MD,
Orthopedic Surgeon at LC Clinic, Jundiai-SP Brazil, Brazil.


Introduction: Current evidence supports the use of radial pressure wave and focused extracorporeal shock wave treatment (ESWT) for the treatment of chronic plantar fasciitis that does not improve with conservative treatment. Studies show that a quarter of plantar fasciitis may have an associated neuropathic component and the literature shows that neuropathic pain causes more intense pain and greater functional disability. However, there is a lack of literature on the results of ESWT in tendinopathies associated with the neuropathic pattern.
Case report: We report a case of plantar fasciitis with central sensitization and associated neuropathic component. At first, pregabalin 75mg twice a day was used, which improved the neuropathic pattern. After that, 3 sessions were performed with piezoelectric ESWT with energy of 0.12 mJ/mm2, 2000 impulses at a frequency of 8 Hz, once a week for three weeks. The patient was followed up for 3 months and had complete improvement of symptoms without functional limitation for activities of daily living.
Conclusion: This case report serves to draw attention to the importance of evaluating and treating the neuropathic pattern associated with tendinopathies in order to optimize the therapeutic result. However, randomized clinical trials are lacking to determine the real difference in results between using ESWT in nociceptive pain or in mixed pain with an associated neuropathic component.

Keywords: Chronic pain, plantar fasciitis, mixed pain, neuropathic pain, shockwaves.


1. 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.
2. Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg. 2018 Mar-Apr;57(2):370-381. doi: 10.1053/j.jfas.2017.10.018.
3. Wheeler PC. Neuropathic pain may be common in chronic lower limb tendinopathy: a prospective cohort study. Br J Pain. 2017 Feb;11(1):16-22. doi: 10.1177/2049463716680560.
4. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (Dn4). Pain. 2005 Mar;114(1-2):29-36. doi: 10.1016/j.pain.2004.12.010.
5. Santos JG, Brito JO, de Andrade DC, Kaziyama VM, Ferreira KA, Souza I, Teixeira MJ, Bouhassira D, Baptista AF. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2010 May;11(5):484-90. doi: 10.1016/j.jpain.2009.09.014.
6. Maki M, Ikoma K, Kido M, Hara Y, Sawada K, Ohashi S, Kubo T. Magnetic resonance imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy. Foot (Edinb). 2017 Dec;33:25-28. doi: 10.1016/j.foot.2017.10.002.
7. Wheeler PC. Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients. Br J Pain. 2019 Aug;13(3):137-144. doi: 10.1177/2049463718800352.
8. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, Freeman R, Truini A, Attal N, Finnerup NB, Eccleston C, Kalso E, Bennett DL, Dworkin RH, Raja SN. Neuropathic pain. Nat Rev Dis Primers. 2017 Feb 16;3:17002. doi: 10.1038/nrdp.2017.2.
9. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17(9):1113-e88. doi: 10.1111/j.1468-1331.2010.02999.x.
10. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, Gilron I, Haanpää M, Hansson P, Jensen TS, Kamerman PR, Lund K, Moore A, Raja SN, Rice AS, Rowbotham M, Sena E, Siddall P, Smith BH, Wallace M. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015 Feb;14(2):162-73. doi: 10.1016/S1474-4422(14)70251-0.
11. Gerdesmeyer L, Frey C, Vester J, Maier M, Weil L Jr, Weil L Sr, Russlies M, Stienstra J, Scurran B, Fedder K, Diehl P, Lohrer H, Henne M, Gollwitzer H. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. Am J Sports Med. 2008 Nov;36(11):2100-9. doi: 10.1177/0363546508324176.
12. Gollwitzer H, Saxena A, DiDomenico LA, Galli L, Bouché RT, Caminear DS, Fullem B, Vester JC, Horn C, Banke IJ, Burgkart R, Gerdesmeyer L. Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. J Bone Joint Surg Am. 2015 May 6;97(9):701-8. doi: 10.2106/JBJS.M.01331.
13. Morrissey D, Cotchett M, Said J’Bari A, Prior T, Griffiths IB, Rathleff MS, Gulle H, Vicenzino B, Barton CJ. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. Br J Sports Med. 2021 Oct;55(19):1106-1118. doi: 10.1136/bjsports-2019-101970.


How to Cite this article: Camargo Lsd, Kobayashi R |Extracorporeal shock wave treatment in plantar fasciitis with an associated neuropathic component. How to optimize the result?. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 21-23.

[Full Text HTML] [Full Text PDF] [XML]

Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin

Abstract  | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 26 | Antonio Déniz Cáceres, Pedro Saavedra Santana, María Isabel Marrero Arencibia, Jaime Hernández Alemán ,Almudena Hernández
DOI: 10.13107/jrs.2022.v02.i02.65

Author: Antonio Déniz Cáceres [1], Pedro Saavedra Santana [2], María Isabel Marrero  Arencibia [3], Jaime Hernández Alemán [4], Almudena Hernández [4]

[1] Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.

[2] Department of Mathematics, Universidad de Las Palmas de Gran Canaria, Spain.

[3] Department of Biochemestry and Molecular Biology, Universidad de Las Palmas de Gran Canaria, Spain.

[4] Universidad de Las Palmas de Gran Canaria, Spain.

Address of Correspondence
Dr. Antonio Déniz Cáceres, MD, PhD,
Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.


Introduction: Spasticity is a common complication in patients with brain damage secondary to stroke and multiple sclerosis, generating
disability and reducing the quality of life. In cases of muscles spasticity, we usually use Botulinum toxin injections (BTI) associated with
physiotherapy. Extracorporeal shock wave therapy (ESWT) is a safe, effective, and non-invasive treatment in these patients. Both methods are highly effective but currently are applied separately. Scientific evidence of the combined use of both techniques is scarce. The aim of this study is to assess the results of the association of both treatments (ESWT and BTI). On spasticity in patients secondary to stroke or multiple sclerosis.
Materials and Methods: This is a prospective study, with 6-month follow-up, including 10 adult patients with stroke or multiple sclerosis. ESWT was added to the usual treatment with BTI weekly for 3 weeks. The patients received rehabilitation during the treatment period and during the follow-up period. For statistical analysis in each of the follow-up weeks, the markers analyzed (spasticity and gait speed) were summarized in medians, which were plotted as a weekly function and the paired data were compared with the Wilcoxon test. The data were analyzed with an statistical program version 3.6.1 (R Development Core Team, 2019).
Results and Conclusions: We observed a statistically significant improvement in spasticity that was correlated with an increase in walking speed. The effectiveness of the combined treatment was superior and lasted longer than BTI alone.
Keywords: Shockwaves, Spasticity, Brain damage, Botulinum Toxin


How to Cite this article: Deniz A, Saavedra P, Marrero I, Hernández J, Hernández A | Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 26.

[Full Text HTML] [Full Text PDF] [XML]