449 The Efficiency of Non-surgical Therapies for the Treatment of Mortons Neuroma: A Systematic Review

Abstract

INTRODUCTION: Morton’s neuroma or Intermetatarsal neuroma is a benign inflammation of the peripheral nerves in the feet causing sharp, burning metatarsalgia and significant morbidity while walking, running, etc. It occurs more in females because tight shoe styles put pressure on the nerve. METHODS: Keyword search of “Morton’s Neuroma”, “treatment”, “conservative” and “non-surgical” was conducted across MEDLINE, EMBASE, and Cochrane databases. Two cohort studies and seven Randomised Controlled Trials were included for review following PRISMA guidelines. These studies were reviewed for pain relief, functionality, and limitations of each procedure. RESULTS: Methylprednisolone injections were proved to reduce the Visual Analog Scale score with >50% cases showing no difficulty in functional daily activity at 9 months post-procedure. Short-term relief was achieved by alcohol and capsaicin injections independently. Modifications in the shoe insole indicated better functionality and analgesia compared to a flat insole but combined with steroids it showed better outcomes. Extracorporeal shockwave therapy provided relief for up to 3 months compared to radiofrequency ablation which provided relief for a longer period. CONCLUSIONS: Although these procedures show statistically significant changes, they are not without limitations. Well-designed randomized controlled trials looking into the avenues for radiofrequency ablation and shockwave therapies as opposed to surgical excision of neuromas are vital.