Title : Efficacy of ultrasound-guided steroid injections in the management of Morton’s neuroma: A retrospective cohort study
Abstract:
Background: Morton’s neuroma is a common painful neuropathy of the forefoot, characterised by fibrotic thickening of the plantar digital nerves. Patients typically present with forefoot pain, burning, tingling or numbness, most commonly affecting the third webspace. The exact aetiology remains unclear, although chronic repetitive microtrauma is the most widely accepted theory. UltraSound-guided (US) corticosteroid injections are used for symptom relief; however, their efficacy and factors influencing treatment response remain uncertain.
Methods: This retrospective cohort study evaluated the efficacy of US-guided corticosteroid injections for pain associated with Morton’s neuroma and investigated whether neuroma size influenced pain severity or treatment response. Data were obtained from SECTRA IDS7 and included age, sex, smoking status, neuroma size, and pre- and post-injection Visual Analogue Scale (VAS) pain scores. Statistical analyses included analysis of variance (ANOVA), Spearman’s rank correlation coefficient and the Wilcoxon signed-rank test. Statistical significance was defined as p<0.05.
Results; Twenty eligible patients were included. Seventeen patients (85%) reported a reduction in pain following US-guided corticosteroid injection. The median duration of pain relief was 17 months (IQR 18 months; Q1=6, Q3=24). Mean VAS pain scores decreased significantly from 7.7 before injection to 2.2 after injection (p=0.006). Neuroma size at the time of ultrasound assessment was not significantly associated with baseline pain severity or reduction in pain score following injection (p=0.767). Female patients demonstrated a greater reduction in VAS pain scores than male patients; however, this difference was not statistically significant (p=0.33). Six patients (30%) subsequently underwent surgical intervention.
Conclusions: US-guided corticosteroid injections were associated with significant pain reduction in the majority of patients with Morton’s neuroma, with variable duration of symptomatic relief. Neuroma size did not appear to influence treatment response. No complications were observed in this cohort. Larger prospective studies are required to further investigate predictors of treatment response, including the potential influence of sex and neuroma size, and to identify patients who may benefit from earlier surgical intervention.
