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Therapeutic Ultrasound For Mortons Neuroma?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kerrie, Apr 27, 2011.

  1. Kerrie

    Kerrie Active Member


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    Hi All,
    I was just wondering if any of y'all have used therapeutic ultrasound on a mortons neuroma.
    If so, what W/cm2, MHz and Time?
    Just trying to think of all the things I can throw at a patient before she finally goes down the surgery route, which she is trying to avoid at all costs
    Cheers
     
  2. Page23

    Page23 Active Member

    I'm not really certain how beneifical this would be given that the therapy would do nothing to aid a healing process and restoration of tissues to within nomrmal limits. At best you may establish some very short term pain relief as the ultrasund works on the free nerve endings.
     
  3. I would suggest ( probably more than suggest) that it´s not going to work.

    Off to surgery
     
  4. Kerrie

    Kerrie Active Member

    Yeah that's my thought but she don't want it although I did agree a 6 month treatment regime with her and made her agree..nicely...that if nothing improves in that time she is off to surgery.
     
  5. Page23

    Page23 Active Member

    Could try corticosteroid injection before surgery.
     
  6. Kerrie

    Kerrie Active Member

    Yeah I've told her that but she does not like the idea of 'temporary relief' and in my experience with neuromas I have noticed that a steroid injection will only give relief for 3 months max if they are lucky, but then maybe our guy doing it needs to sharpen his technique
     
  7. Page23

    Page23 Active Member

    Indeed, outcomes are variable with any local steroid injection. Other than a risk of sepsis and a bit of short term pain the patient has very little to lose through trying it. If she doesn't like the idea of temporay relief then she has two options...
     
  8. bob

    bob Active Member

    Sepsis? I'm with Michael on the ultrasound idea. If the patient is not keen on trying a corticosteroid injection given the potential for only short term relief, then I can not see the rationale for them having therapeutic ultrasound. Having said all that, if the patient does not want surgery then they are welcome to try lots of other things. I am loathe to operate unless patients have tried other things first anyway. If the ultrasound works, great (but i'd be surprised).
     
  9. David Wedemeyer

    David Wedemeyer Well-Known Member

    Actually USD can be beneficial but it is far less effective than a local for nerve complaints. USD is thought to have a sedative effect on the nerves but in truth it is hit and miss and the evidence for has never caught up to the claimed benefit. That said I can vouch that it is useful at times.

    When treating irregular surfaces such as the hand and foot I submerge the limb in water and perform the USD subaqueously. 3 Mhz sound head, 2 Watts/cm2, pulsed 15 minutes.

    I'd love to hear back the results if you decide to try it Kerrie.
     
  10. Page23

    Page23 Active Member

    bob; Sepsis?

    Yes, although rare, that and the possibility of post injection pain/flare are the greatest riks associated any local steroid injection, are they not?
     
  11. bob

    bob Active Member

    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001687/

    Yes, sort of. When going through the consent process, we are supposed to discuss frequent or serious risks with a patient. Frequent would be post injection pain or steroid flare, serious would be infection, so you're right. I am unaware of any case of systemic infection following a corticosteroid injection to the foot and ankle, so I do not routinely cite that as a risk. Do you? I generally talk about risks such as treatment failure, skin discolouration, steroid flare and infection. I might also talk about specific risks such as fat pad atrophy with repeated injections for neuromas for example. I realise there is much variation across the country (UK) in the process - some use consent forms as part of this, some do not. It is a grey area and there is no right or wrong answer, but I am curious to know how practice differs, even from country to country. However, I am aware that this is a deviation from the original question and I agree that an injection is a good alternative to explore.
     
  12. Page23

    Page23 Active Member

    I agree that the risk of sepsis is low with corticosteroid injection if performed (as is should be) using an aseptic technique. I detail the risk of this to the patient but outline that realistically it's no more risky than any other injection. Further, I detail post injection flare, pain and fat pad atrophy as being more realistic. As I'm sure you are aware, there are other adverse effects, and I will outline these as well if relevant to the patient. I did read a case of lateral plantar nerve damage using a medial approach for plantar fasciitis. I probably wouldn't detail this unless a patient was particularly demanding of outcomes for this treatment. Overall, I think a formal consent form for this would be useful with listed adverse outcomes. I think part of the problem historically is that many surgeons don't really consider this an invasive procedure when clearly it is. There was a paper about that also which I could reference if you would like it?
     
  13. bob

    bob Active Member

    Yes please. I do not routinely use a consent form for injections in my practice. I know that there are some surgery units in the country that do, but there are probably more that do not. I have not seen any other disciplines using forms as part of the process (other than some physios) but I suppose you can never be too careful. Consent is an interesting area and while the form is only one small attempt at evidencing that we are following the process I wonder how useful it would be if we ever need it in defending a case following an injection? Thankfully I have avoided that particular problem so far!
     
  14. Page23

    Page23 Active Member

  15. bob

    bob Active Member

    Hello,
    Thanks for those. Quite interesting to note that the consent form study shows minimal orthopods using the forms. I always write about the injection in the patient's notes and give advice leaflets, etc... as standard so I am following the recommendations of that paper even though I do not use a consent form for injections - happy days!
     
  16. Page23

    Page23 Active Member

    May the 4th be with you, Bob.
     
  17. bob

    bob Active Member

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