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Review
. 2004;2004(3):CD003118.
doi: 10.1002/14651858.CD003118.pub2.

Interventions for the treatment of Morton's neuroma

C E Thomson  1 , J N A Gibson, D Martin
Affiliations
Review

Interventions for the treatment of Morton's neuroma

C E Thomson et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become anxious about walking or even putting their foot to the ground. Insoles, corticosteroid injections, excision of the nerve, transposition of the nerve and neurolysis of the nerve are commonly used treatments. Their effectiveness is poorly understood.

Objectives: To examine the evidence from randomised controlled trials concerning the effectiveness of interventions in adults with Morton's neuroma.

Search strategy: We searched the Cochrane Neuromuscular Disease Group trials register (searched January 2003), MEDLINE (January 1966 to January Week 2 2003), EMBASE (January 1980 to February Week 2 2003), and CINAHL (January 1982 to February Week 1 2003).

Selection criteria: Randomised or quasi-randomised (methods of allocating participants to an intervention which were not strictly random e.g. date of birth, hospital record, number alternation) controlled trials of interventions for Morton's neuroma were selected. Studies where participants were not randomised into intervention groups were excluded.

Data collection and analysis: Two reviewers selected trials for inclusion in the review, assessed their methodological quality and extracted data independently.

Main results: Three trials involving 121 people were included. There is, at most, a very limited indication that transposition of the transected plantar digital nerve may yield better results than standard resection of the nerve in the long term. There is no evidence to support the use of supinatory insoles. There are, at best, very limited indications to suggest that dorsal incisions for resection of the plantar digital nerve may result in less symptomatic post-operative scars when compared to plantar excision of the nerve.

Reviewers' conclusions: There is insufficient evidence with which to assess the effectiveness of surgical and non-surgical interventions for Morton's neuroma. Well designed trials are needed to begin to establish an evidence base for the treatment of Morton's neuroma pain.

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Conflict of interest statement

None

Update of

  • doi: 10.1002/14651858.CD003118

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References

References to studies included in this review

Colgrove 2000 {published data only}
    1. Colgrove R, Huang E, Barth A, Greene M. Interdigital neuroma: intermuscular neuroma transposition compared with resection. Foot & Ankle International 2000;21(3):206‐11. - PubMed
Kilmartin 1994 {published data only}
    1. Kilmartin TE, Wallace WA. Effect of pronation and supination orthosis on Morton's neuroma and lower extremity function. Foot & Ankle International 1994;15(5):256‐62. - PubMed
Nashi 1997 {published data only}
    1. Nashi M, Venkatachalam A, Muddu B. Surgery of Morton's neuroma: dorsal or plantar approach?. Journal of the Royal College of Surgeons (Edinburgh) 1997;42(1):36‐7. - PubMed

References to studies excluded from this review

Guiloff 1979 {published data only}
    1. Guiloff RJ. Carbamazepine in Morton's neuralgia. British Medical Journal 1979;2(6195):904. - PMC - PubMed
Quinn 1999 {published data only}
    1. Quinn SG, Raja F, Raja D. A study to measure the efficacy of injectable betamethasone (Betnesol) for the treatment of Morton's neuroma. British Journal of Podiatry 1999:130‐1.
Rasmussen 1996 {published data only}
    1. Rasmussen MR, Kitaoka HB, Patzer GL. Non operative treatment of plantar interdigital neuroma with a single corticosteroid injection. Clinical Orthopaedics and Related Research 1996;326:188‐93. - PubMed
Wolfort 2001 {published data only}
    1. Wolfort SF, Dellon AL. Treatment of recurrent neuroma of the interdigital nerve by implantation of the proximal nerve into muscle in the arch of the foot. Journal of Foot and Ankle Surgery 2001;40(6):404‐10. - PubMed

Additional references

Algan 2003
    1. Algan H, Baykan A. Cryoanalgesia relieves neuroma pain. Proceedings of the 4th Congress of EFIC‐The European Federation of the International Association for the Study of Pain, Prague. Prague: The European Federation of the International Association for the Study of Pain, 2003.
Barret 1994
    1. Barret SL, Pignetti TT. Endoscopic decompression for intermetatarsal nerve entrapment ‐ the EDIN technique: preliminary study with cadaveric specimens; early clinical results. The Journal of Foot and Ankle Surgery 1994;33(5):503‐8. - PubMed
Basadonna 1999
    1. Basadonna P, Rucco V, Gasparini D, Onorato A. Plantar fat pad atrophy after corticosteroid injection for an interdigital neuroma: A case report. American Journal of Physical Medicine and Rehabilitation 1999;78(3):283‐5. - PubMed
Beech 2000
    1. Beech I, Rees S, Tagoe M. Clinical audit of the surgical management of plantar digital neuroma. The Foot 2000;10:31‐5.
Bennett 1995
    1. Bennett GL, Graham CE, Mauldin DM. Morton's interdigital neuroma: a comprehensive treatment protocol. Foot and Ankle International 1995;16(12):760‐3. [MEDLINE: ] - PubMed
Bourke 1994
    1. Bourke G, Owen J, Machet D. Histological comparison of the third interdigital nerve in patients with Morton's metatarsalgia and control patients. Australian and New Zealand Journal of Surgery 1994;64(6):421‐4. [MEDLINE: ] - PubMed
Cashley 2000
    1. Cashley D. Manipulative therapy in the treatment of plantar digital neuritis (Morton's neuroma). British Journal of Podiatry. 2000;3(3):67‐9.
Coughlin 2000
    1. Coughlin MJ. Common causes of pain in the forefoot in adults. Journal of Bone and Joint Surgery 2000;82(6):781‐90. - PubMed
Dellon 1992
    1. Dellon LA. Treatment of Morton's neuroma as a nerve compression. The role for neurolysis. Journal of the American Podiatric Medicine Association 1992;82(8):399‐402. - PubMed
Dockery GL 1999
    1. Dockery GL. The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. Journal of Foot and Ankle Surgery 1999;38(6):403‐8. - PubMed
Finney 1989
    1. Finney W, Wiener SN, Catanzariti F. Treatment of Morton's neuroma using percutaneous electrocoagulation. Journal of the American Podiatric Medicine Association 1989;79(12):615‐8. - PubMed
Gauthier 1979
    1. Gauthier G. A nerve entrapment syndrome. A new surgical technique. Clinical Orthopaedics & Related Research 1979;142:90‐3. [MEDLINE: ] - PubMed
Gaynor 1989
    1. Gaynor R, Hake D, Spinner SM, Tomczak RL. A comparative analysis of conservative versus surgical treatment of Morton's neuroma. Journal of the American Podiatric Medicine Association 1989;79(1):27‐30. [MEDLINE: ] - PubMed
Greenfield 1984
    1. Greenfield J, Rea J, Ilfield F. Morton's interdigital neuroma: indications for treatment by local injections versus surgery. Clinical Orthopaedics & Related Research 1984;185:142‐4. [MEDLINE: ] - PubMed
GRO Scotland 1999
    1. General Register Office for Scotland. http://www.gro‐scotland.gov.uk/grosweb/grosweb.nsf/pages/home.
Hirschberg 2000
    1. Hirschberg GG. A simple cure for Morton's neuralgia. Journal of the American Podiatric Medical Association 2000;90(2):100‐1. - PubMed
Hodor 1997
    1. Hodor L, Barkal K, Hatch‐Fox LD. Cryogenic denervation of the intermetatarsal space neuroma. Journal of Foot and Ankle Surgery 1997;36(4):311‐4. - PubMed
Keh 1992
    1. Keh RA, Ballew KK, Higgins KR, Odom R, Harkless LB. Long‐term follow‐up of Morton's neuroma. Journal of Foot Surgery 1992;31(1):93‐5. - PubMed
Mann 1983
    1. Mann R, Reynolds J. Interdigital neuroma: A critical analysis. Foot and Ankle International 1983;3(4):238‐43. - PubMed
McQuay 1997
    1. McQuay HJ, Moore RA, Eccleston C, Morley S, Williams AC. Systematic review of outpatient services for chronic pain control. Health Technology Assessment 1997;1(6):1‐135. [MEDLINE: ] - PubMed
Moher 2001
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357(9281):585. - PubMed
Nunan 1997
    1. Nunan PJ, Giesy BD. Management of Morton's neuroma in athletes. Clinics in Podiatric Medicine and Surgery 1997;14(3):489‐501. - PubMed
Okafor 1997
    1. Okafor B, Shergill G, Angel J. Treatment of Morton's neuroma by neurolysis. Foot & Ankle International 1997;18(5):284‐7. [MEDLINE: ] - PubMed
Oliver 1998
    1. Oliver TB, Beggs I. Ultrasound in the assessment of Metatarsalgia: a surgical and histological correlation. Clinical Radiology 1998;53(4):287‐9. - PubMed
Peto 1976
    1. Peto R, Pike MC, Armitage P. Design and analysis of randomised clinical trials requiring prolonged observation of each patient. British Journal of Cancer 1976;34:585‐612. - PMC - PubMed
Price 1992
    1. Price BA, Miller G. Internal neurolysis. Journal of Foot Surgery 1992;31(3):250‐9. - PubMed
Quirk 1987
    1. Quirk R. Morton's neuroma. Australian Family Physician 1987;16(8):1117‐20. - PubMed
Reddy 1995
    1. Reddy PD, Zelicof SB, Ruotolo C, Holder J. Interdigital Neuroma: Local cutaneous changes after corticosteroid injection. Clinical Orthopaedics and Related Research 1995;317:185‐7. - PubMed
Richardson 1993
    1. Richardson EG, Brotzman SB, Graves SC. The plantar incision for procedures involving the forefoot. An evaluation of one hundred and fifty incisions in 115 patients. Journal of Bone and Joint Surgery 1993;75(5):726‐31. - PubMed
Schroven 1995
    1. Schroven I, Geutjens G. Results of excision of the interdigital nerve in the treatment of Morton's metatarsalgia. The Foot 1995;5:196‐8. - PubMed
Thomson 2001
    1. Thomson C, Campbell R, Wood A, Rendall G. Disorders of the adult foot. In: Lorimer, et al. editor(s). Neale's Disorders of the Foot. 6th Edition. Edinburgh: Churchill Livingstone, 2001.
Tollafield 1996
    1. Tollafield D, Williams H. The use of two injectable corticosteroid preparations used in the management of foot problems ‐ a clinical report. Journal of British Podiatric Medicine 1996;51(12):171‐4.
Tugwell 1987
    1. Tugwell P, Bombardier C, Buchanan W, Goldsmith C, Grace E, Hanna B. The MACTAR Patient Preference Disability Questionnaire ‐ an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. Journal of Rheumatology 1987;14(3):446‐51. - PubMed
Wilson 1995
    1. Wilson S, Kuwada G. Retrospective study of the use of a plantar transverse incision versus dorsal incision for excision of neuroma. The Journal of Foot & Ankle Surgery 1995;34(6):537‐40. - PubMed
Wu 1996
    1. Wu KK. Morton's interdigital neuroma: a clinical review of its etiology, treatment and results. Journal of Foot and Ankle Surgery 1996;35(2):112‐9. - PubMed