TREATMENT OF MORTON’S NEUROMA – WHICH TREATMENT WORKS BEST?

Abstract

A prospective study of 72 patients with Morton’s neuroma was carried out outlining presenting symptoms, significance of clinical examination and the beneficial effect of various treatment modalities. They were followed up for at least 6 weeks. There were 51 females (70%) and 21 males (30%) with average age of 52 years.

Bilateral symptoms were present in 15% cases with remaining 85% cases having unilateral symptoms. Commonest symptom observed was pain in the web space, commonest being 3^rd space (70%) and others being 2^nd space (18%), 4^th space (4%) and combination of two spaces (8%). In 90% of these cases, pain was aggravated by walking and wearing closed shoes; and relieved by taking rest.

Paraesthesia in adjacent toes was present in 46% cases. Clinically palpable Mulder’s click was seen in 54% cases.

Shoe modification was tried in 33% patients, with little benefit. All 72 patients underwent corticosteroid and local anaesthetic injection in the outpatient clinic. Fair to good pain relief was obtained in 76% cases with average duration of pain relief of 2.8 weeks (range (0–8 weeks)). No pain relief was achieved in 24% cases.

Twenty-eight patients (38%) who either had inadequate pain relief at 6 weeks following injection; or had recurrence of pain eventually underwent surgical excision/decompression using plantar approach. None of them had any complication related to surgery. All patients had excellent pain relief at a minimum of 6 months follow up after the surgery. 90 % of the patients who underwent surgery had VAS pain score of 0 at 6 months follow up.

Thus, single injection treatment is a very useful treatment modality achieving satisfactory results in 76% of patients. Surgical excision/decompression should be reserved for patients with no pain relief/recurrence after the injection.