Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma.
Markovic M, Crichton K, Read JW, Lam P, Slater HK. Foot Ankle Int. 2008 May;29(5):483-7.
I had a lady of 45 who presented with medial heel pain. At the time I diagnosed plantar fasciitis. Fitted bespoke semi flexible orthoses and reviewed after 6 weeks.
The outcome was relief of pain initialy then return of pain slightly higher in the medial heel at the level of the heel rim. I removed the rearfoot post and reviewed after 2 weeks, the pain had very significantly increased. Further examination changed my Dx to tarsal tunnel syndrome and severe pain could be ellicited by palpation of the medial calcaneal nerve and tapping sent tingling and pain thru the medial foot. This was not apparent at the first visit. I replaced the posting and increased the medial wedge and the pain eased considerably over the next week.
She is a nurse at the local hospital and I had arranged for a diagnositic U/S scan. She has not had the scan yet but her freind heard about her heel and wheeled her in to see the local orthpaedic consultant who immediately gave her a corticosteroid injection, which was very painful to administer and remained that way, and told her to stop using the orthoses. During this time she has been seeing our physio for theraputic U/S and 1 week after the steroid injection she is back in considerable pain. I still plump for tarsal tunnel syndrome but I feel I have lost control of her future treatment for now. Maybe she'll listen to me at her next appointment.
Just an anecdote really but relevant to the thread.
Patient's assessment of discomfort during ultrasound-guided injection of Morton's neuroma: selecting the optimal approach.
Yap LP, McNally E. J Clin Ultrasound. 2012 Jul-Aug;40(6):330-4
Methylprednisolone injections for the treatment of morton neuroma: a patient-blinded randomized trial.
Thomson CE, Beggs I, Martin DJ, McMillan D, Edwards RT, Russell D, Yeo ST, Russell IT, Gibson JN. J Bone Joint Surg Am. 2013 May 1;95(9):790-8.
Cost-effectiveness of steroid (methylprednisolone) injections versus anaesthetic alone for the treatment of Morton¿s neuroma: economic evaluation alongside a randomised controlled trial (MortISE trial)
Rhiannon Tudor Edwards, Seow Tien Yeo, Daphne Russell, Colin E Thomson, Ian Beggs, J N Alastair Gibson, Diane McMillan, Denis J Martin and Ian T Russell Journal of Foot and Ankle Research 2015, 8:6
doi:10.1186/s13047-015-0064-y
What factors predict the need for further intervention following corticosteroid injection of Morton's neuroma?
Devendra Mahadevan, Mohammad Salmasi, Nicola Whybra, Anika Nanda, Suchi Gaba, Jitendra Mangwani Jnl Foot Ankle Surg; Article in Press
Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma
Stefan N. van Vendeloo, Harmen B. Ettema Foot and Ankle Surgery; 21 January 2016
Corticosteroid injection for Morton's neuroma with or without ultrasound guidance: a randomised controlled trial.
Mahadevan D et al Bone Joint J. 2016 Apr;98-B(4):498-503.
Risk factors and the associated cutoff values for failure of corticosteroid injection in treatment of Morton’s neuroma
Young Hwan ParkJa Woon LeeGi Won ChoiHak Jun Kim International Orthopaedics: 12 December 2017
Prediction of Clinical Prognosis according to Intermetatarsal Distance and Neuroma Size on Ultrasonography in Morton Neuroma: A Prospective Observational Study.
Park YH et al J Ultrasound Med. 2019 Apr ;38(4):1009-1014
Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review
Steven R Edwards, Susannah Fleming, Karl B Landorf J Am Podiatr Med Assoc. 2021 Jul 1;111(4)