Systematic Review and Meta-analysis of Radiofrequency Ablation for Morton's Neuroma: Outcomes and Predictors of Success

Abstract

Objective: Morton's neuroma presents a challenge in terms of pain management. This study aimed to evaluate the available evidence on the efficacy and safety of radiofrequency ablation for Morton's neuroma.

Design: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Prospective clinical trials, cohort studies, and case series were also included. Data analysis was performed using Review Manager 5.4. Meta-analysis applied fixed- or random-effects models depending on the heterogeneity. Sensitivity analyses were performed to assess the effects of temperature, radiofrequency cycles, and imaging guidance.

Results: Eight studies ( N = 237) were included. Significant pain reduction was observed at the final follow-up (mean difference = 5.74; 95% confidence interval = 5.58, 5.90). At the final follow-up, 47.57% (95% confidence interval = 25.13%-70.00%) experienced complete pain relief, while 16.40% (95% confidence interval = 11.86%-20.94%) reported no benefit at final follow-up. Sensitivity analyses found higher-temperature settings (≥85°C) conferred greater relief on visual analog scale (mean difference = -6.97; 95% confidence interval = -6.75 to -7.18) compared to temperatures <85°C (mean difference = -3.94; 95% confidence interval = -3.68 to -4.19). Fewer radiofrequency cycles (≤3) also demonstrated significantly greater visual analog scale improvement (mean difference = -6.97; 95% confidence interval = -6.75 to -7.18) versus >three cycles (mean difference = -4.79; 95% confidence interval = -3.02 to -6.57). Complications were minimal (2.1%), and most resolved without significant interventions.

Conclusions: Radiofrequency ablation, particularly at specific temperatures and cycle thresholds, is effective and safe for the management of Morton's neuroma.

To claim cme credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

Cme objectives: Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients.

Level: Advanced.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Keywords: Foot Pain; Meta-analysis; Morton’s Neuroma; Radiofrequency.