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Published on: May 26, 2023
Ultrasound-guided Morton's neuroma injection: the "three-handed" technique and initial outcomes: a retrospective
Oded Stav1, Raphael Israeli2, Matityahu Nof3
1Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel.
Background:
Morton's neuroma is a painful forefoot condition commonly treated with corticosteroid injections. Although ultrasound guidance improves injection accuracy, various single-operator approaches exist with differing reproducibility and technical challenges. This study describes and evaluates a novel " three-handed " ultrasound-guided technique involving coordinated manipulation by both a radiologist and an injecting physician, hypothesized to enhance the therapeutic response while maintaining a low complication rate.
Methods:
We retrospectively reviewed the data of 56 evaluable patients (selected from a total of 110 treated patients) with symptomatic Morton's neuroma. The technique involved a radiologist applying dorsal compression to stabilize the neuroma while an orthopaedic surgeon performed a plantar, ultrasound-guided injection of 1 cc betamethasone. The primary outcome was patient-reported pain relief at ≥ one month follow-up, categorized as significant (> 50% relief), partial (30-50%), or minimal (< 30%).
Results:
The cohort (n = 56; 75.0% female; mean age 54.3 ± 11.4 years) had a mean follow-up of 9.5 months. Significant improvement (> 50% pain reduction) was reported by 75.0% (42/56) of the patients. The overall clinical response rate (pain reduction > 30%) was 80.4% (of 45/56). The outcomes were not significantly different (p = 0.746) between the one-site (n = 33) and two-site (n = 23) injection groups. No major complications occurred, and 8.9% (5/56) of the patients reported transient pain.
Conclusions:
Ultrasound-guided three-handed technique is a safe and feasible method for Morton's neuroma injection. This cooperative approach enhances neuroma stabilization and needle visualization, yielding high rates of preliminary clinical improvement. These retrospective findings are limited by selection bias and lack of control. Prospective randomized trials are warranted to validate its efficacy against standard single-operator techniques.
