BACKGROUND: The effectiveness of corticosteroid injection for the treatment of Morton's neuroma is unclear. In addition, most of the studies related to it are case-control or retrospective case series. The purpose of this study was to compare the effectiveness between corticosteroid injection associated with local anesthetic and local anesthetic alone (placebo control group) for the treatment of Morton's neuroma.
METHODS: Forty-one patients with a diagnosis of Morton's neuroma were randomized to receive 3 injections of either a corticosteroid plus a local anesthetic or a local anesthetic alone. The patients and the researcher who collected data were blinded to the treatment groups. The visual analog scale for pain and the American Orthopaedic Foot & Ankle Score (metatarsophalangeal/interphalangeal score) were obtained at baseline, after each injection, and at 3 and 6 months after the last injection.
RESULTS: There were no significant between-group differences in terms of pain and function improvement at 3 and 6 months after treatment completion in comparison with baseline values. At the end of the study, 17 (48.5%) patients requested surgical excision of the neuroma: 7 (44%) in the experimental group and 10 (53%) in the control group ( P = 1.0).
CONCLUSION: The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton's neuroma.
LEVEL OF EVIDENCE: Level I, randomized controlled trial.
The study showed: The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton’s neuroma.
This is a well done RCT that answers the question of the effectiveness of corticosteroid injection with local anesthetic vs local anesthetic alone for the treatment of Morton’s neuroma. It is clear from this article that the risks of adding corticosteroids outweigh the benefits. Articles like this help to guide/change practice and it is important information for Surgeons that deal with Morton's neuroma.
I do not commonly encounter Morton's neuromas in my general internal medicine population. Were I to encounter one, I would probably refer the patient to a podiatrist. Therefore, this article, while interesting and informative, has, for me, very little significance.