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Efficacy of a Single Corticosteroid Injection for Morton's Neuroma in Adults: A Systematic Review

Steven R. Edwards
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Susannah Fleming
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Karl B. Landorf
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Background

Morton's neuroma is a common condition that routinely presents in podiatric practice. The aim of this study was to systematically synthesize the evidence relating to the effectiveness of a corticosteroid injection for Morton's neuroma.

Methods

Studies with a publication date of 1960 or later were eligible, and searches were performed within the Turning Research Into Practice database; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register; MEDLINE (Ovid); PubMed; Embase; Cumulative Index to Nursing and Allied Health Literature; and the gray literature. Study selection criteria included randomized and nonrandomized controlled trials where a single corticosteroid injection for Morton's neuroma pain was investigated. The primary outcome was Morton's neuroma pain as measured by any standard validated pain scale.

Results

Ten studies involving 695 participants were included. The quality of the studies was considered low and subject to bias. Of the included studies, five compared corticosteroid injection to usual care, one compared corticosteroid injection to local anesthetic alone, one compared ultrasound-guided to non–ultrasound-guided injections, three compared corticosteroid injections to surgery, one compared small to large neuromas, six assessed patient satisfaction, four measured adverse events, one studied return to work, and one examined failure of the corticosteroid injection to improve pain. Overall, these studies identified a moderate short- to medium-term benefit of corticosteroid injections on the primary outcome of pain and a low adverse event rate.

Conclusions

A single corticosteroid injection appears to have a beneficial short- to medium-term effect on Morton's neuroma pain. It appears superior to usual care, but its superiority to local anaesthetic alone is questionable, and it is inferior to surgical excision. A very low adverse event rate was noted throughout the studies, indicating the intervention is safe when used for Morton's neuroma. However, the quality of the evidence is low, and these findings may change with further research.

Australasian College of Podiatric Surgeons, Melbourne, Victoria, Australia.

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.

Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia.

Corresponding author: Steven R. Edwards, MSc(Oxon), Australasian College of Podiatric Surgeons, 2/1 Lansdown St, Hampton, Victoria 3188, Australia. (E-mail: s6edwards@gmail.com)