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Short term comparison between blind and ultrasound guided injection in morton neuroma

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

The aim of this work is to compare the effectiveness of blind and ultrasound-guided injection for Morton’s neuroma (MN) to determine which is more appropriate as the initial procedure in conservative treatment.

Methods

This is an evaluator-blinded randomised trial. Of the 56 included patients, 27 were assigned to the blind group (A) and 29 to the ultrasound-guided group (B). Injection includes 1 ml of 2% mepivacaine and 40 mg of triamcinolone in each web space with MN. The included patients were assessed clinically by VAS score and the Manchester Foot Pain and Disability Score (MFPDS). The follow-up was performed at 15 days, 1 month, 45 days, 2 months, 3 months and 6 months after the initial injection.

Results

No differences in age or clinical measurements were found at presentation between group A and group B. At the follow-up, the ultrasound-guided group showed greater symptomatic relief at several stages of the follow-up: 45 days (VAS 3.0 ± 0.5 versus 5.5 ± 0.5, p = 0.001; MFPDS: 32.2 ± 1.8 versus 38.8 ± 2.0, p = 0.018), 2 months (VAS: 3.1 ± 0.5 versus 5.6 ± 0.5, p = 0.002; MFPDS: 31.5 ± 1.9 versus 38.5 ± 2.1, p = 0.020) and 3 months (VAS: 3.1 ± 0.4 versus 5.2 ± 0.6, p = 0.010; MFPDS: 31.2 ± 1.9 versus 37.7 ± 2.4, p = 0.047).

Conclusion

Injection of MN under ultrasound guidance provides a statistically significant improvement at some stages of the follow-up (45 days, 2 and 3 months), compared with blind injection.

Key Points

• Ultrasound-guided steroid injections in Morton’s neuroma provide short-term pain relief to over 60% of the patients.

• Ultrasound-guided injections in Morton’s neuroma lead to a higher percentage of short-term pain relief than blind injections.

• Ultrasound-guided injections in Morton’s neuroma lead to a lower percentage of skin side effects than blind injections.

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Abbreviations

MFPDS:

Manchester Foot Pain and Disability Score

MN:

Morton’s neuroma

US:

Ultrasound

VAS:

Visual analogue scale

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Acknowledgements

Thanks to Loreto Vasquez for her kind collaboration reviewing the English grammar of the article and to Manuela Exposito Ruiz for her statistical support.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Traumatology Hospital (University Hospital Virgen de las Nieves), C-Julio Verne 8, 7 B, 18003, Granada, Spain

    Fernando Ruiz Santiago, Pablo Tomás Muñoz, Luis Guzmán Álvarez & Alberto Martínez Martínez

  2. Department of Orthopedic Surgery, University Hospital Virgen de las Nieves, Granada, Spain

    Nicolás Prados Olleta

Authors
  1. Fernando Ruiz Santiago
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  2. Nicolás Prados Olleta
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  3. Pablo Tomás Muñoz
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  4. Luis Guzmán Álvarez
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  5. Alberto Martínez Martínez
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Corresponding author

Correspondence to Fernando Ruiz Santiago.

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Guarantor

The scientific guarantor of this publication is Fernando Ruiz Santiago

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Manuela Exposito Ruiz, from FIBAO, Hospital Virgen de las Nieves, kindly provided statistical advice for this manuscript.

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• randomised controlled trial

• performed at one institution

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Ruiz Santiago, F., Prados Olleta, N., Tomás Muñoz, P. et al. Short term comparison between blind and ultrasound guided injection in morton neuroma. Eur Radiol 29, 620–627 (2019). https://doi.org/10.1007/s00330-018-5670-1

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  • DOI: https://doi.org/10.1007/s00330-018-5670-1

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