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Foot and Ankle Surgery : Official... Aug 2018The treatment of Morton's neuroma (MN) can be operative, conservative and infiltrative. Our aim was the evaluation of evidence on outcomes with different types of... (Review)
Review
BACKGROUND
The treatment of Morton's neuroma (MN) can be operative, conservative and infiltrative. Our aim was the evaluation of evidence on outcomes with different types of conservative, infiltrative and surgical treatment in patients affected by primary MN.
METHODS
The bibliographic search was conducted in MEDLINE, Cochrane Library, DARE. Only studies in English were collected. The last search was in August 2015. Case series and randomized controlled trials (RCTs) assessing patients' satisfaction or pain improvement at an average follow-up of at least 6 months after treatment of primary MN were included. Two reviewers selected the studies, evaluated their methodological quality, and retrieved data independently.
RESULTS
Of 283 titles found, only 29 met the inclusion criteria. Data showed better outcomes with operative treatment.
CONCLUSIONS
The evaluated case series and few RCTs showed better results with invasive treatment. More and better RCTs which evaluate risk-benefit ratio are required to confirm these results.
Topics: Humans; Morton Neuroma
PubMed: 29409240
DOI: 10.1016/j.fas.2017.03.010 -
Journal of Foot and Ankle Research 2019Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Morton's neuroma (MN) is a compressive neuropathy of the common plantar digital nerve. It is a common compressive neuropathy often causing significant pain which limits footwear choices and weight bearing activities. This paper aims to review non-surgical interventions for MN, to evaluate the evidence base for the clinical management of MN.
METHODS
Electronic biomedical databases (CINAHL, EMBASE, MEDLINE and Cochrane) were searched to January 2018 for studies evaluating the effectiveness of non-surgical interventions for Morton's neuroma. Outcome measures of interest were treatment success rate (SR) (binary) and pain as measured using 100-point visual analogue scale (VAS) (continuous). Studies with and without control groups were included and were evaluated for methodological quality using the Downs and Black Quality Index. Results from randomised controlled trials (RCT) were compared between-groups, and case series were compared pre- versus post-treatment. Effect estimates are presented as odds ratios (OR) for binary data or mean differences (MD) for continuous data. Random effects models were used to pool effect estimates across studies where similar treatments were used. Heterogeneity was assessed using the statistic.
RESULTS
A total of 25 studies met the inclusion criteria, seven RCTs and 18 pre/post case series. Eight different interventions were identified, with corticosteroid or sclerosing injections being the most often reported (seven studies each). Results from a meta-analysis of two RCTs found corticosteroid injection decreased pain more than control on VAS (WMD: -5.3, 95%CI: -7.5 to - 3.2). Other RCTs reported efficacy of: manipulation/mobilisation versus control (MD: -15.3, 95%CI: -29.6 to - 1.0); extracorporeal shockwave therapy versus control (MD: -5.9, 95%CI: -21.9 to 10.1). Treatment success was assessed for extracorporeal shockwave therapy versus control (OR: 0.3, 95%CI: 0.0 to 7.1); and corticosteroid injection vs footwear/padding (OR: 6.0, 95%CI: 1.9 to 19.2). Sclerosing and Botox injections, radiofrequency ablation and cryoneurolysis have been investigated by case series studies, however these were of limited methodological quality.
CONCLUSIONS
Corticosteroid injections and manipulation/mobilisation are the two interventions with the strongest evidence for pain reduction, however high-quality evidence for a gold standard intervention was not found. Although the evidence base is expanding, further high quality RCTs are needed.
Topics: Foot Orthoses; Glucocorticoids; Humans; Morton Neuroma; Musculoskeletal Manipulations; Pain Management; Randomized Controlled Trials as Topic; Sclerotherapy
PubMed: 30809275
DOI: 10.1186/s13047-019-0320-7 -
Foot and Ankle Surgery : Official... Oct 2020Non-surgical treatment for Morton's neuroma: a systematic review.
TITLE
Non-surgical treatment for Morton's neuroma: a systematic review.
BACKGROUND
Morton's neuroma (MN) is an entrapment degenerative neuropathy with a strong predilection for the 3rd interdigital web space. The objective of our study was to identify the most significant evidence produced for the non-operative treatment of Morton's neuroma and assess outcomes of these interventions.
METHOD
The electronic databases Medline, Ovid EMBASE, CINAHL and Cochrane CENTRAL from inception to October 2018 were searched. Two independent reviewers assessed the quality of the studies using the Modified Coleman Criteria. Statistics were combined across cohort studies to calculate pooled mean results, and improvements in outcomes.
RESULTS
Initial electronic and hand search identified 486 studies. After title and abstract review there were 38 that went on to full-text review. Finally, 22 studies were included in the final review. We identified 9 different non-operative treatment modalities; Corticosteroid injection, Alcohol injection, Extra-corporeal Shockwave therapy (ESWT), Radiofrequency Ablation (RFA), Cryoablation, Capsaicin injection, Botulinum toxin, Orthosis and YAG Laser Therapy. Corticosteroid showed a statistically significant reduction in mean VAS over all their studies (p < 0.01), with 50% success at 12 months. Alcohol showed promising short-term pain-relieving results only. Orthotics, Capsaicin injections, Cryoablation, Botulinum toxin, RFA and ESWT did show statistically significant improvements, but with limitation to their application.
CONCLUSION
Following review, the authors would recommend the use of corticosteroid injections to treat Morton's neuromas. The authors feel that radio-frequency ablation and cryoablation would benefit from further well designed randomised controlled trials.
Topics: Conservative Treatment; Humans; Morton Neuroma; Nerve Compression Syndromes; Patient Reported Outcome Measures
PubMed: 31718949
DOI: 10.1016/j.fas.2019.09.009 -
Journal of Foot and Ankle Research Sep 2023Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this study was to conduct a systematic review and meta-analysis to compare the surgical results of dorsal and plantar approaches.
METHODS
The literatures of PubMed, Cochrane library, Embase and Web of Science were searched on April 26th, 2023. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The data were extracted after screening the literature and evaluating the quality of the methodology included in the study. The RevMan5.4 software was used to analyze and calculate the OR value and 95% confidence interval.
RESULTS
A total of 7 randomized controlled trials and comparative studies were published, of which only 5 were included. There were 158 feet via plantar approach (plantar group, PG) and 189 via dorsal approach (dorsal group, DG). There was no significant difference between PG and DG in overall adverse events, sensory problems, incision infection and deep vein thrombosis (p > 0.05). In terms of scar problems, PG showed more than DG (OR, 2.90[95%CI, 1.40 to 5.98]; p = 0.004). Other outcome indicators such as visual analogue scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were difficult to be included in the comparison.
CONCLUSIONS
Based on the relatively low quality and small amount of available evidence, the meta-analysis conducted produces a hypothesis that the frequency of adverse events in surgical treatment of Morton's neuroma, dorsal approach and plantar approach may be the same, but the types are different. More high-level evidence is needed to further verify this hypothesis.
Topics: Humans; Morton Neuroma; Consensus; Lower Extremity; Orthopedics; Software
PubMed: 37674248
DOI: 10.1186/s13047-023-00660-w -
Journal of the American Podiatric... 2022Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders.
METHODS
The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included.
RESULTS
A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001).
CONCLUSIONS
The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton's neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
Topics: Achilles Tendon; Ankle; Extracorporeal Shockwave Therapy; Fasciitis, Plantar; Heel Spur; Humans; Morton Neuroma; Tendinopathy; Treatment Outcome
PubMed: 34878537
DOI: 10.7547/18-191 -
European Radiology Aug 2015To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To compare ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of Morton's neuroma.
METHODS
Studies that assessed the diagnostic accuracy of US and MRI for Morton's neuroma were retrieved from major medical libraries independently by two reviewers up to 1 April 2014. Predefined inclusion and exclusion criteria were adopted.
RESULTS
277 studies were initially found, and the meta-analysis was conducted on 14 studies. US sensitivity was studied in five studies, MRI sensitivity in three studies, and bothin six studies. All studies used surgery as the reference standard. A high sensitivity (SE) of diagnostic testing was observed for both US (SE (95 % CI) = 0.91 (0.83-0.96)) and MRI (SE (95 % CI) = 0.90 (0.82-0.96)) with no significant differences between the two modalities in diagnosis (Q test p = 0.88). For MRI, specificity of test was 1.00 with a pooled estimation of 1.00 (0.73-1.00), while the pooled specificity was 0.854 (95 % CI: 0.41-1.00) for US. No differences were observed between US and MRI in study design (p = 0.76).
CONCLUSION
This meta-analysis shows that the SE of US (0.91) is equal to (p = 0.88) that of MRI (0.90) for identification of Morton's neuroma.
KEY POINTS
• For Morton's neuroma, US sensitivity is equal to MRI. • US is as accurate as MRI in diagnosing Morton's neuroma. • US may be the most cost-effective imaging method for Morton's neuroma.
Topics: Adult; Aged; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Peripheral Nervous System Neoplasms; Sensitivity and Specificity; Ultrasonography
PubMed: 25809742
DOI: 10.1007/s00330-015-3633-3 -
Journal of the American Podiatric... Jul 2014Morton's neuroma is a frequently painful condition of the forefoot, causing patients to seek medical care to alleviate symptoms. A plethora of therapeutic options is... (Review)
Review
BACKGROUND
Morton's neuroma is a frequently painful condition of the forefoot, causing patients to seek medical care to alleviate symptoms. A plethora of therapeutic options is available, some of which include injection therapies. Researchers have investigated injection therapy for Morton's neuroma, and latterly the evidence base has been augmented with methods that use diagnostic ultrasound as a vehicle to deliver the injectate under image guidance for additional accuracy. To date, there seems to be no consensus that ultrasound-guided injections provide better therapeutic outcomes than nonguided injections for the treatment of Morton's neuroma.
METHODS
A systematic review was chosen because this method can undertake such a process. The review process identified 13 key papers using predetermined inclusion and exclusion criteria, which then underwent methodological quality assessment using a pretested Quality Index. A narrative synthesis of the review findings is presented in light of the heterogeneity of the data from the extraction process.
RESULTS
This systematic review provides an argument that ultrasound guidance can produce better short- and long-term pain relief for corticosteroid injections, can reduce the need for additional procedures in a series of sclerosing alcohol injections, can reduce the surgical referral rate, and can add efficacy to a single injection.
CONCLUSIONS
Ultrasound guidance should be considered for injection therapy in the management of Morton's neuroma.
Topics: Forefoot, Human; Glucocorticoids; Humans; Injections, Intralesional; Neuroma; Peripheral Nervous System Neoplasms; Sclerosing Solutions; Ultrasonography, Interventional
PubMed: 25076076
DOI: 10.7547/0003-0538-104.4.337 -
Acta Neurochirurgica Feb 2021Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Individual evidence suggests that multiple modalities can be used to treat entrapment pathology by Morton's neuroma, including injection, neurolysis, and neurectomy. However, their impacts on patient pain and satisfaction have yet to be fully defined or elucidated. Correspondingly, our aim was to pool systematically identified metadata and substantiate the impact of these different modalities in treating Morton's neuroma with respect to these outcomes.
METHODS
Searches of 7 electronic databases from inception to October 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidences of outcomes were extracted and pooled by random-effects meta-analysis of proportions.
RESULTS
A total of 35 articles satisfied all criteria, reporting a total of 2998 patients with Morton's neuroma managed by one of the three modalities. Incidence of complete pain relief after injection (43%; 95% CI, 23-64%) was significantly lower than neurolysis (68%; 95% CI, 51-84%) and neurectomy (74%; 95% CI, 66-82%) (P = 0.02). Incidence of complete satisfaction after injection (35%; 95% CI, 21-50%) was significantly lower than neurolysis (63%; 95% CI, 50-74%) and neurectomy (57%; 95% CI, 47-67%) (P < 0.01). The need to proceed to further surgery was significantly greater following injection (15%; 95% CI, 9-23%) versus neurolysis (2%; 95% CI, 0-4%) or neurectomy (5%; 95% CI, 3-7%) (P < 0.01). Incidence of procedural complications did not differ between modalities (P = 0.30).
CONCLUSIONS
Although all interventions demonstrated favorable procedural complication incidences, surgical interventions by either neurolysis or neurectomy appear to trend towards greater incidences of complete pain relief and complete patient satisfaction outcomes compared to injection treatment. The optimal decision-making algorithm for treatment for Morton's neuroma should incorporate these findings to better form and meet the expectations of patients.
Topics: Denervation; Humans; Injections; Morton Neuroma; Nerve Block; Patient Satisfaction; Retrospective Studies
PubMed: 32056015
DOI: 10.1007/s00701-020-04241-9 -
Clinics in Orthopedic Surgery Jun 2021This review aimed to evaluate the effects of corticosteroid injections on Morton's neuroma using an algorithmic approach to assess the methodological quality of reported...
BACKGROUD
This review aimed to evaluate the effects of corticosteroid injections on Morton's neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework.
METHODS
Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton's neuroma. Data search, extraction, analysis, and quality assessments were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). guidelines, and clinical outcomes were evaluated using various outcome measures.
RESULTS
With 3-12 months of follow-up, corticosteroid injections provided satisfactory outcomes according to Johnson satisfaction scores except in two studies. Visual analog scale scores showed maximal pain reduction between 1 week and 3 months after injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain.
CONCLUSIONS
Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton's interdigital neuroma although almost 30% of the included subjects eventually underwent operative treatment. Our recommendation for future research includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies on the safety and effectiveness of multiple injections at the same site are highly necessary.
Topics: Adrenal Cortex Hormones; Disability Evaluation; Humans; Injections, Intralesional; Morton Neuroma; Pain Measurement; Patient Satisfaction; Surveys and Questionnaires
PubMed: 34094019
DOI: 10.4055/cios20256 -
Clinical Radiology Apr 2015To determine the accuracy of MRI versus ultrasound for Morton's neuroma. (Meta-Analysis)
Meta-Analysis Review
AIM
To determine the accuracy of MRI versus ultrasound for Morton's neuroma.
MATERIALS AND METHODS
A search was undertaken for clinical studies published in any language in PubMed up to the date of December 2013. Studies assessing the accuracy of the ultrasound or MRI for the diagnosis of Morton's neuroma were included. Data were pooled for meta-analysis. Study selection, data collection, and extraction were performed independently by two authors. Meta-disc 1.4 and Revman 5.2 software were applied for statistical analysis.
RESULTS
The study included 12 studies; 217 patients underwent MRI and 241 underwent ultrasound examinations. There appeared greater diagnostic accuracy for ultrasound than MRI for the diagnosis of Morton's neuroma (ultrasound sensitivity 90%, specificity 88%, positive likelihood ratio 2.77, negative likelihood ratio 0.16 versus MRI sensitivity 93%, specificity 68%, positive likelihood ratio 1.89, negative likelihood ratio 0.19).
CONCLUSIONS
The available evidence suggests that ultrasound can provide better accuracy for the diagnosis of Morton's neuroma than MRI.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography; Young Adult
PubMed: 25466436
DOI: 10.1016/j.crad.2014.10.017