[Percutaneous ultrasound-guided neurolysis with local administration of betamethasone in the treatment of Morton's neuroma].

Abstract

Morton's neuroma is one of the most common entrapment mononeuropathies of peripheral nerves. The main clinical manifestation is neuropathic pain syndrome in the foot. Currently, many methods of treatment are proposed. Despite the advantages of each method, the main disadvantages are low effectiveness, aggravation of symptoms due to scar-related complications, or relatively high incidence of complications following surgical invasion.

Objective: To evaluate the effectiveness of percutaneous ultrasound-guided neurolysis with local administration of betamethasone in patients with Morton's neuroma.

Material and methods: The study included 14 female patients aged 24-56 years (mean 44.7±6.4). We analyzed VAS scores of pain syndrome (mean 7.1±1.1) and DN4 scores of neuropathic pain (mean 4.9±0.9). Ultrasound imaging was performed to estimate localization and volume of neuroma. Mean volume of neuroma was 226±142 mm³.

Results: Mean follow-up was 12 months. In 12 out of 14 patients, there was a significant decrease in pain intensity to VAS score 1.1±0.6 and regression of neuropathic pain to DN4 score 0.5±0.5. In 2 cases, neuropathic pain recurred after 6 months with enlargement of neuromas (to 429 and 452 mm³). There were no complications in any patient.

Conclusion: Percutaneous ultrasound-guided neurolysis of Morton's neuroma with local administration of betamethasone is an effective and promising minimally invasive method. Selection criterion for this procedure may be small volume of neuroma. Further research is required to clarify the indications for this procedure.