Manipulation versus steroid injection in the treatment of Morton's neuroma: a randomized control trial

Manipulative therapy's rationale is pragmatically appealing as a noninvasive treatment for Morton's Neuroma, involving targeted manipulations of the metatarsophalangeal joints. Nevertheless, manipulation's efficacy has received limited scrutiny.

An exploratory, pragmatic randomized clinical trial was designed to investigate the efficacy of an acute, short dosage (6, weekly episodes) of physiologically principled manipulations, featuring discrete, high-velocity thrusting maneuvers for treating Morton's Neuroma. Adults electing treatment for Morton's Neuroma were randomly allocated to manipulative therapy (n = 29) or corticosteroid injection (n = 32). Baseline and follow-up (at 1.5, 3, 6, 9 and 12 months following treatment cessation) outcome measures of self-reported pain levels; pressure testing for discomfort thresholds; and functionality; pain and social interaction; activities of daily living and sports participation were measured ipsilaterally and by inventory.

Manipulation elicited substantive gains immediately after intervention (visual analog scale for Pain [Cohen's d, 3.3; 84.4%]; pressure threshold testing [d, 2.3; 147.0%]; functionality [d, 1.4; 52.8%]; pain [d, 1.3; 45.5%]; social interaction [d, 0.9; 39.2%]) or accumulated during follow-up (daily living [d, 2.2; 40.8%]; sport [d, 1.5; 66.1%]). Concomitant gains for control participants were modest (d, 0.4 to 1.0; 16.6% to 45.9%) (p < 0.05 to p < 0.0005). Retention of improvements following manipulation cessation was substantial for all metrics, significantly better than baseline scores and consistently exceeded that for corticosteroid injection (p < 0.01 to p < 0.001).

Manipulation elicited significant and clinically relevant improvements and retention in self-reported levels of pain, discomfort and functionality for patients electing treatment for Morton's neuroma.