Radiofrequency Ablation for the Management of Morton's Neuroma

NewsBot · May 18, 2017

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Three Cycles of Radiofrequency Ablation Are More Efficacious Than Two in the Management of Morton's Neuroma.
Brooks D, Parr A, Bryceson W
Foot Ankle Spec. 2017 May 1:1938640017709905. doi: 10.1177/1938640017709905

BACKGROUND:
Morton's neuroma is a common cause of forefoot pain. Outcomes of conservative therapy are mixed and many patients undergo operative intervention. Radiofrequency ablation has recently gained favor as a treatment option, although the optimal regime is unknown. This study investigates the effectiveness of 2 versus 3 cycles of radiofrequency ablation for the treatment of Morton's neuroma.
METHODS:
We surveyed a cohort of patients with Morton's neuroma who had progressed to radiofrequency ablation after failed conservative treatment. Patients received either 2 or 3 cycles of radiofrequency ablation by a single surgeon. We assessed patients based on their change in numerical pain rating scale, symptom improvement, complications, and progression to surgical excision through a series of telephone interviews. Outcomes between the 2 treatment arms were compared by parametric tests.
RESULTS:
Twenty-eight patients were included in the study. Eighteen patients with 21 neuromas received 2 cycles and 10 patients with 11 neuromas received 3 cycles. Mean time of follow-up was 12.9 months. Overall, 88% of patients were either very or moderately satisfied with their outcome. In patients who received 2 cycles mean numerical pain scores decreased from 7.9 ± 1.1 to 3.4 ± 2.4 postprocedure. Three patients progressed to operative excision. In patients who received 3 cycles, numerical pain scores decreased from 8.0 ± 1.0 to 1.5 ± 2.0 postprocedure. One patient progressed to operative excision. Patients who received 3 cycles had reduced medium-term pain postoperatively compared with 2 cycles (3.4 ± 2.4 vs 1.5 ± 2.0, P = .011).
CONCLUSION:
Radiofrequency ablation provides a high rate of patient satisfaction in the treatment of Morton's neuroma with few side effects. It appears that 3 cycles may be superior to 2 cycles but a randomized controlled trial will be required to confirm these results.
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Admin2 · May 18, 2017

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NewsBot · Oct 3, 2017

Ultrasound-Guided Percutaneous Radiofrequency for the Treatment of Morton’s Neuroma
Salvatore Masala et al
CardioVascular and Interventional Radiology 27 September 2017

Purpose
Morton’s neuroma (MN) is a leading cause of disability. The purpose of this study was to investigate the effectiveness of radiofrequency (RF) in patients with chronic pain refractory to conservative therapies.

Methods
Between September 2012 and December 2016, RF was performed on 52 patients. A sterile RF needle probe (22G, 5-cm needle with 10-mm electrode active tip) was inserted between the toes into the intermetatarsal space at the center of the lesion. Potential complications of the intervention and post-procedure care were examined. All patients provided written, informed consent. All percutaneous procedures were performed with the NeuroTherm® NT1100 (Neurotherm Inc., M.) device and using ultrasound guidance (Philips IU22). Continuous RF was performed with one cycle of 90 s and with the probe tip maintaining a temperature of 85 °C (impedance 95–210 mΩ).

Results
Mean VAS score before the procedures was 9.0 ± 0.6. A reduction of pain intensity was achieved after 1 week by RF (mean VAS scores 3.7 ± 0.9; p < 0.05), with a stabilization of the painful symptomatology in the following months and after 1 year of treatments (mean VAS scores 2.0 ± 0.4 after 12 months, p < 0.05). The FHSQ scores showed improved quality of life (QOL) in all patients at 6 months (p < 0.05) and 1 year (p < 0.05) of RF. No patients developed complications.

Conclusions
RF is a safe, efficient, and minimally invasive technique for the treatment of symptomatic MN.
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NewsBot · May 8, 2018

Ultrasound guided radiofrequency ablation of Morton’s neuroma: A substitute for surgery
Ahmed M. Bassiouny
The Egyptian Journal of Radiology and Nuclear Medicine; 3 May 2018

Objectives
To assess the efficacy of radiofrequency ablation of Morton's neuroma (MN) as a substitute to surgery, in patients not responding to conservative treatment.

Methods
15 patients, who performed radiofrequency ablation (RFA) of Morton's neuroma between November 2015 and December 2016, were submitted to follow up to assess the response to therapy over a period of 6 months by assessment of pain relief through visual analogue scale (VAS) scale from 1 to 10 from least to severe pain.

Results
All of the 15 patients suffered from intense pain during their normal daily activity prior to RF ablation, pretreatment VAS average was 7.

Follow up of the patients was done after 1 week, 1 month, 3 months and 6 months.

After RF ablation, pain disappeared in 9 cases (60%), 3 had mild pain (20%), 2 moderate pain (13.3%) and 1 with severe pain (6.6%) and proceeded to surgery. Complete resolution of pain was encountered in the patients with mild and moderate pain with conservative or second session of RFA.

Conclusion
Radiofrequency ablation of Morton's neuroma, is an effective technique in treatment of symptomatic patient's after failure of conservative treatment and prior to surgical intervention.
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NewsBot · Aug 14, 2019

Ultrasound-guided radiofrequency ablation for treatment of Morton's neuroma: initial experience
R.ShahaM.AhmadaD.Hanu-CernatbS.Choudharya
Clinical Radiology; 10 August 2019

Highlights
•Ultrasound guided radiofrequency ablation is a safe and effective treatment for symptomatic Morton‘s neuroma of the foot.
•Real time US guidance during continuous radiofrequency demonstrating an ‘ablation zone’ helps guide duration of RFA treatment.
•Further studies on long term outcomes and comparison to other management options will be required to establish its role in management of symptomatic Morton's neuroma.
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AIM
To assess the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for treatment of symptomatic Morton's neuroma.

MATERIALS AND METHODS
Patients with symptomatic Morton's neuroma of the foot were referred for treatment with RFA, prior to consideration for surgery. All neuromas were proven by ultrasound imaging and had a trial of conservative management including orthotic support and/or steroid injections. Ultrasound-guided RFA was performed as an outpatient procedure under local anaesthetic. Patients were followed up at 8 weeks and 8 months. Outcomes were assessed with a visual analogue scale (VAS) score, Manchester–Oxford Foot and Ankle Questionnaire, overall patient satisfaction, and complications.

RESULTS
Twenty-two neuromas were treated with RFA under ultrasound guidance. The VAS score at 8 weeks was significantly lower than the VAS score pre-procedure (p<0.001, Wilcoxon signed ranks test) and the VAS score at 8 months was significantly lower than the VAS score at 8 weeks (p=0.008, Wilcoxon signed ranks test). At 8 months, 89% of treated patients were satisfied with the procedure outcome. No significant adverse effects were recorded.

CONCLUSION
Ultrasound-guided RFA is safe, with excellent initial results in treatment of symptomatic Morton's neuroma. Further studies on long-term outcomes and comparison to other management options will be required to establish its role in management of symptomatic Morton's neuroma.
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NewsBot · May 3, 2020

Radiofrequency Ablation for the Treatment of Painful Neuroma.
Connors JC et al
J Foot Ankle Surg. 2020 May - Jun;59(3):457-461

Mechanical compression of interdigital nerves beneath the deep transverse intermetatarsal ligament and between the metatarsal heads leads to painful irritation and possible fibrosis. Conservative measures of padding and injections often fail to provide long-term relief. Surgical excision provides definitive relief, but the procedure is not without risk. Incomplete excision and stump neuroma formation are a few of the possible complications associate with open excision. This retrospective cohort study was performed to provide a review of the available literature on the identification and treatment of interdigital neuromas and to examine the overall incidence of patient satisfaction after radiofrequency ablation as definitive treatment for interdigital neuroma formation. This study population consisted of 32 patients (25 females and 7 males with 1 patient having bilateral procedures) with a mean age of 46.3 ± 17 (range 31 to 65) years. For all procedures, the median patient satisfaction score was 92.5 (interquartile range 50 to 100) of 100, with a mean follow-up period of > 2.5 years. Only 1 patient in the study population reported no relief after 3 total procedures. Radiofrequency ablation offers a minimally invasive alternative with a short postoperative recovery course and considerably fewer complications compared with surgical excision of the intermetatarsal neuroma as described in prior reports.
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