Radiofrequency neurolysis versus surgical neurectomy for Morton's Neuroma

Morton's neuroma is one of the most common forefoot pathologies. In recent years, radiofrequency ablation has emerged as a minimally invasive alternative to surgical excision, aiming to relieve symptoms while reducing morbidity.

To compare the efficacy and safety of radiofrequency neurolysis and surgical excision for the treatment of Morton's neuroma at our institution.

A single-center, observational, retrospective, and longitudinal study was conducted including patients treated between 2012 and 2022. Clinical data from patients who underwent either surgical excision or radiofrequency ablation were analyzed. Demographic characteristics, pain intensity assessed using the Visual Analog Scale (VAS), complication rates, and reintervention rates were recorded, with a minimum follow-up of two years. Statistical analysis was performed using SPSS version 25.

A total of 192 procedures were identified (110 surgical excisions and 82 radiofrequency ablations). For analyses focused on demographic and baseline characteristics, repeated procedures performed in the same patient were grouped, resulting in 144 unique cases (92 excisions and 52 radiofrequency ablations). Both techniques resulted in significant pain reduction. Surgical excision achieved greater VAS improvement (- 5.57) compared with radiofrequency ablation (- 4.3). Complications were more frequent after surgical excision (13%) than after radiofrequency ablation (3.7%). In the radiofrequency group, 26% of patients required subsequent surgical excision and 33% underwent repeat ablation. The use of radiofrequency increased from 20% during 2012-2017 to 57% during 2018-2022.

Radiofrequency ablation is a safe and effective treatment for Morton's neuroma, although its analgesic effect appears less durable than surgical excision. Its low complication rate and outpatient applicability make it a valuable alternative, particularly in selected patients.