Radiofrequency Thermo-Ablation of Morton’s Neuroma: A Valid Minimally Invasive Treatment Procedure in Patients Resistant to Conservative Treatment

Abstract

Background: The authors present the personal results of the review of a group of cases treated for Morton’s neuroma with continuous radiofrequency (CRF) thermo-ablation of the plantar intermetatarsal nerve. Methods: This retrospective review consisted of 29 patients treated between January 2008 and December 2011, with a minimum 1 year follow-up. Three patients underwent bilateral treatment and 10 patients underwent concomitant treatment procedures for associated foot disorders: hallux valgus (7), tailor’s bunion (2) and hammertoe (5). The procedure was performed in a day hospital setting under direct fluoroscopic control. Results: The follow-up protocol used a visual analog scale (VAS) for pain (0 = no pain, 10 = worst pain) and a visual analog scale (VAS) for patient satisfaction (0 = no satisfaction, 10 = complete satisfaction). Success was defined by a decrease of 5 points in pain at 1 year after the treatment procedure. From these 29 cases, with a VAS pain score between severe and worst pain ever, treatment with CRF thermo-ablation at one year follow-up yielded these results: 14 cases with no pain (48%), 7 cases with mild pain (24%), 5 cases with moderate pain (17%), 3 cases still with severe pain (10%). The overall benefit was that 88% of the patients had significant pain improvements. From another point of view, 26 cases (89.6%) had a decrease of the VAS score between 5 and 10 points and in only 3 cases (10.3%) severe pain was reported, even though it was slightly diminished after the procedure. Conclusion: Continuous radiofrequency (CRF) thermo-ablation of Morton’s neuroma (Entrapment) was a safe and minimally invasive surgical procedure which gave these patients great satisfactions and a rapid return to normal activity.

 

 

Share and Cite:

R. Paolo, A. Roberto and B. Mihai, "Radiofrequency Thermo-Ablation of Morton’s Neuroma: A Valid Minimally Invasive Treatment Procedure in Patients Resistant to Conservative Treatment," Open Journal of Orthopedics, Vol. 3 No. 8, 2013, pp. 325-330. doi: 10.4236/ojo.2013.38060.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] T. G. Morton, “A Peculiar and Painful Affection of the Fourth Metatarsophalangeal Articulation,” American Journal of the Medical Sciences, Vol. 71, No. 141, 1876, pp. 37-45.
http://dx.doi.org/10.1097/00000441-187601000-00002
[2] M. Frascarelli, M. Urciolo, P. Monachino, M. Baleanu and G. Favilli, “La Sindrome di Morton. (Valutazione Elettromiografica),” Chirurgia Del Piede, Vol. 22, No. 3, 1998, pp. 151-155.
[3] A. Viladot, “Metatarsalgia Due to Biomechanical Alterations of the Forefoot,” Orthopedic Clinics of North America, Vol. 4, No. 1, 1973, pp. 165-178.
[4] J. D. Mulder, “The Causative Mechanism in Morton’s Metatarsalgia,” The Journal of Bone & Joint Surgery British, Vol. 33, 1951, pp. 94-95.
[5] S. L. Barrett, E. Rabat, M. Buitrago, V. P. Rascon and P. D. Applegate, “Endoscopic Decompression of Intermetatarsal Nerve(EDIN) for the Treatment of Morton’s Entrapment-Multicenter Retrospective Review,” Open Journal of Orthopedics, Vol. 2, No. 2, 2012, pp. 19-24.
[6] E. R. Cosman Jr. and E. R. Cosman Sr., “Electric and Thermal Field Effects in Tissue around Radiofrequency Electrodes,” Pain Medicine, Vol. 6, No. 6, 2005, pp. 405-424. http://dx.doi.org/10.1111/j.1526-4637.2005.00076.x
[7] L. Todorov, “Pulsed Radiofrequency of the Sural Nerve for the Treatment of Chronic Ankle Pain,” Pain Physician, Vol. 14, No. 3, 2011, pp. 301-304.
[8] J. Zundert, P. Raj, S. Erdine and M. van Kleef, “Application of Radiofrequency Treatment in Practical Pain Management: State of the Art,” Pain Practice, Vol. 2, No. 3, 2002, pp. 269-278.
http://dx.doi.org/10.1046/j.1533-2500.2002.02036.x
[9] J. Van Zundert, A. J. de Louw, E. A. Joosten, A. G. Kessels, W. Honig, P. J. Dederen, et al., “Pulsed and Continuous Radiofrequency Current Adjacent to the Cervical Dorsal Root Ganglion of the Rat Induces Late Cellular Activity in the Dorsal Horn,” Anesthesiology, Vol. 102, No. 1, 2005, pp. 125-131.
http://dx.doi.org/10.1097/00000542-200501000-00021
[10] W. Rea, S. Kapur and H. Mutagi, “Radiofrequency Therapies in Chronic Pain,” Continuing Education in Anaesthesia, Critical Care & Pain, Vol. 11, No. 2, 2011, pp. 35-38. http://dx.doi.org/10.1093/bjaceaccp/mkq057

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.