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Scientific Articles   |    
Methylprednisolone Injections for the Treatment of Morton NeuromaA Patient-Blinded Randomized Trial
Colin E. Thomson, BSc(Hons), PhD1; Ian Beggs, FRCPE, FRCR2; Denis J. Martin, DPhil, MSc, BSc(Hons)3; Diane McMillan, BSc(Hons)1; Rhiannon Tudor Edwards, BSc, MA, DPhil4; Daphne Russell, PhD, MA, DipMathStat4; Seow Tien Yeo, MSc, BSc(Hons)4; Ian T. Russell, MA, MSc, PhD, HonDSc, FSS, MCMI, HonFRCGP, FRCPEd, FFPH4; J.N. Alastair Gibson, MD, FRCSEd, FRCS(Tr&Orth)2
1 Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh EH21 6UU, Scotland. E-mail address for C.E. Thomson: cthomson@qmu.ac.uk
2 Department of Radiology (I.B.) and Musculoskeletal Directorate (J.N.A.G.), The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, Scotland
3 Health and Social Care Institute, Centuria Building, University of Teesside, Middlesbrough TS1 3BA, United Kingdom
4 Institute of Medical and Social Care Research, Dean Street, Bangor University, Gwynedd LL57 2DG, United Kingdom
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Investigation performed at The Royal Infirmary of Edinburgh, Edinburgh, Scotland

A commentary by Ronald W. Smith, MD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 May 01;95(9):790-798. doi: 10.2106/JBJS.I.01780
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Abstract

Background: 

Morton neuroma is a common cause of neuralgia affecting the web spaces of the toes. Corticosteroid injections are commonly administered as a first-line therapy, but the evidence for their effectiveness is weak. Our primary research aim was to determine whether corticosteroid injection is an effective treatment for Morton neuroma compared with an anesthetic injection as a placebo control.

Methods: 

We performed a pragmatic, patient-blinded randomized trial set within hospital orthopaedic outpatient clinics in Edinburgh, United Kingdom. One hundred and thirty-one participants with Morton neuroma (mean age, fifty-three years; 111 [85%] female) were randomized to receive either corticosteroid and anesthetic (1 mL methylprednisolone [40 mg] and 1 mL 2% lignocaine) or anesthetic alone (2 mL 1% lignocaine). An ultrasonographic image was obtained before treatment, and injections were performed with the needle placed under ultrasonographic guidance. The primary outcome was the difference in patient global assessment of foot health between the two groups at three months after injection. This was measured with use of a 100-unit visual analog scale (VAS) anchored by “best imaginable health state” and “worst imaginable health state.”

Results: 

Compared with the control group, global assessment of foot health in the corticosteroid group was significantly better at three months (mean difference, 14.1 scale points [95% confidence interval, 5.5 to 22.8 points]; p = 0.002). The difference between the groups was also significant at one month. Significant and nonsignificant improvements associated with the corticosteroid injection were observed for measures of pain, function, and patient global assessment of general health at one and three months after injection. The size of the neuroma as determined by ultrasonography did not significantly influence the treatment effect.

Conclusions: 

Corticosteroid injections for Morton neuroma can be of symptomatic benefit for at least three months.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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