• 1

    Addante JB, Peicott PS, Wong KY, et al: Interdigital neuromas: results of surgical excision of 152 neuromas. JAPMA 76: 493, 1986.

  • 2

    Bartolomei FJ, Wertheimer SJ: Intermetatarsal neuromas: distribution and etiologic factors. J Foot Surg 22: 279, 1983.

  • 3

    Finney W, Wiener SN, Catanzariti F: Treatment of Morton's neuroma using percutaneous electrocoagulation. JAPMA 79: 615, 1989.

  • 4

    Goldman F: Intermetatarsal neuromas: light and electron microscopic observation. JAPA 70: 265, 1980.

  • 5

    Moore JL, Rosen R, Cohen J, et al: Radiofrequency thermoneurolysis for the treatment of Morton's neuroma. J Foot Ankle Surg 51: 20, 2012.

  • 6

    Sluijter ME: The role of radiofrequency in failed back surgery patients. Curr Rev Pain 4: 49, 2000.

  • 7

    Slappendel R, Crul BJ, Braak GJ, et al: The efficacy of radiofrequency lesioning of the cervical spinal dorsal root ganglion in a double blinded randomized study: no difference between 40 degrees C and 67 degrees C treatments. Pain 73: 159, 1997.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Rozen D, Ahn J: Pulsed radiofrequency for the treatment of ilioinguinal neuralgia after inguinal herniorrhaphy. Mt Sinai J Med 73: 716, 2006.

  • 9

    Bogduk N: Pulsed radiofrequency. Pain Med 7: 396, 2006.

  • 10

    Van Zundert J, de Louw AJ, Joosten EA, et al: Pulsed and continuous radiofrequency current adjacent to the cervical dorsal root ganglion of the rat induces late cellular activity in the dorsal horn. Anesthesiology 102: 125, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Restrepo-Garces CE, Marinov A, McHardy P, et al: Pulsed radiofrequency under ultrasound guidance for persistent stump-neuroma pain. Pain Pract 11: 98, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Byrd D, Mackey S: Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep 12: 37, 2008.

  • 13

    Tekin I, Mirzai H, Ok G, et al: A comparison of conventional and pulsed radiofrequency denervation in the treatment of chronic facet joint pain. Clin J Pain 23: 524, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Basal S, Ergin A, Yildirim I, et al: A novel treatment of chronic orchialgia. J Androl 33: 22, 2012.

  • 15

    Basal S, Goktas S, Ergin A, et al: A novel treatment modality in patients with premature ejaculation resistant to conventional methods: the neuromodulation of dorsal penile nerves by pulsed radiofrequency. J Androl 31: 126, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Atim A, Deniz S, Kurt E: Re: coccygodynia. Pain Pract 11: 507, 2011.

  • 17

    Lee KT, Kim JB, Young KW, et al: Long-term results of neurectomy in the treatment of Morton's neuroma: more than 10 years' follow-up. Foot Ankle Spec 4: 349, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Valente M, Crucil M, Alecci V: Operative treatment of interdigital Morton's neuroma. Chir Organi Mov 92: 39, 2008.

  • 19

    Genon MP, Chin TY, Bedi HS, et al: Radio-frequency ablation for the treatment of Morton's neuroma. ANZ J Surg 80: 583, 2010.

  • 20

    Schreiber K, Khodaee M, Poddar S, et al: Clinical inquiry: what is the best way to treat Morton's neuroma? J Fam Pract 60: 157, 2011.

  • 21

    Cosman ER Jr, Cosman ER Sr: Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med 6: 405, 2005.

  • 22

    Hagiwara S, Iwasaka H, Takeshima N, et al: Mechanisms of analgesic action of pulsed radiofrequency on adjuvant-induced pain in the rat: roles of descending adrenergic and serotonergic systems. Eur J Pain 13: 249, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Van Zundert J, Patijn J, Kessels A, et al: Pulsed radiofrequency adjacent to the cervical dorsal root ganglion in chronic cervical radicular pain: a double blind sham controlled randomized clinical trial. Pain 127: 173, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Van Zundert J, Brabant S, Van de Kelft E, et al: Pulsed radiofrequency treatment of the Gasserian ganglion in patients with idiopathic trigeminal neuralgia. Pain 104: 449, 2003.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Coughlin MJ, Pinsonneault T: Operative treatment of interdigital neuroma: a long-term follow-up study. J Bone Joint Surg Am 83: 1321, 2001.

  • 26

    Cahana A, Van Zundert J, Macrea L, et al: Pulsed radiofrequency: current clinical and biological literature available. Pain Med 7: 411, 2006.

Ultrasound-Guided Pulsed Radio Frequency Treatment in Morton's Neuroma

Suleyman Deniz Department of Anesthesiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.

Search for other papers by Suleyman Deniz in
Current site
Google Scholar
PubMed
Close
 MD
,
Tarik Purtuloglu Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Tarik Purtuloglu in
Current site
Google Scholar
PubMed
Close
 MD
,
Sukru Tekindur Isparta Military Hospital, Isparta, Turkey.

Search for other papers by Sukru Tekindur in
Current site
Google Scholar
PubMed
Close
 MD
,
Kadir Hakan Cansız Elazıg Military Hospital, Elazıg, Turkey.

Search for other papers by Kadir Hakan Cansız in
Current site
Google Scholar
PubMed
Close
 MD
,
Memduh Yetim Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Memduh Yetim in
Current site
Google Scholar
PubMed
Close
 MD
,
Oguz Kılıckaya Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Oguz Kılıckaya in
Current site
Google Scholar
PubMed
Close
 MD
,
Serkan Senkal Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Serkan Senkal in
Current site
Google Scholar
PubMed
Close
 MD
,
Serkan Bilgic Department of Orthopedics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.

Search for other papers by Serkan Bilgic in
Current site
Google Scholar
PubMed
Close
 MD
,
Abdulkadir Atim Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Abdulkadir Atim in
Current site
Google Scholar
PubMed
Close
 MD
, and
Ercan Kurt Department of Anesthesiology, Gulhane Military Medical Academy, Ankara, Turkey.

Search for other papers by Ercan Kurt in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background

Morton's neuroma is a perineural fibrosis of an intermetatarsal plantar nerve. Burning, numbness, paresthesia, and tingling down the interspaces of involved toes may also be experienced. Taking into account all of this information, we designed a prospective open-label study to evaluate the efficacy of pulsed radio frequency on Morton's neuroma.

Methods

Twenty patients with Morton's neuroma were experiencing symptomatic neuroma pain in the foot not relieved by routine conservative treatment. All of the patients had been evaluated by a specialized orthopedist and were offered pulsed radio frequency as a last option before having surgery. Initially, pain level (numerical rating scale), successful pain control (a ≥50% pain decrease was accepted as successful pain control), comfort when walking (yes or no), and satisfaction level (satisfied or not satisfied) were evaluated.

Results

We found a decrease in the pain level in 18 of 20 patients, successful pain control in 12, and wearing shoes and walking without pain in 16. Overall, satisfaction was rated as excellent or good by 12 patients with Morton's neuroma in this series.

Conclusions

This evidence indicates that ultrasound-guided pulsed radio frequency is a promising treatment modality in the management of Morton's neuroma pain.

Corresponding author: Suleyman Deniz, MD, Department of Anesthesiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey. (E-mail: sdeniz.md@gmail.com)