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Ultrasound-guided treatment of Morton’s neuroma

Authors
  • Klontzas, Michail E.1, 2, 3
  • Koltsakis, Emmanouil1
  • Kakkos, George A.1
  • Karantanas, Apostolos H.1, 2, 3
  • 1 Department of Medical Imaging, University Hospital of Heraklion, Crete , (Greece)
  • 2 Advanced Hybrid Imaging Systems, Institute of Computer Science, FORTH, Crete , (Greece)
  • 3 Department of Radiology, School of Medicine, University of Crete, Greece , (Greece)
Type
Published Article
Journal
Journal of Ultrasonography
Publisher
Exeley Inc.
Publication Date
Jun 07, 2021
Volume
21
Issue
85
Identifiers
DOI: 10.15557/JoU.2021.0022
Source
Exeley
Keywords
Disciplines
  • Medicine
License
Green

Abstract

Morton’s neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton’s neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton’s neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton’s neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton’s neuroma, with emphasis on the outcomes of ultrasound-guided treatments.

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