Background and aims Morton’s neuroma (MN) is a common cause of forefoot pain. When conservative treatments are ineffective, ablative (thermal or chemical) or surgical procedures are considered. Recent publications have indicated that applying pulsed radiofrequency (PRF), a non-destructive treatment, to peripheral nerves has been successful in reducing various forms of localized neuropathic pain. The authors are unaware of any reports of isolated PRF treatment for MN.
Here we present a patient with MN originated intractable pain in whom PRF provided long-term pain relief.
Methods A 58-year-old woman with an 8-month history of severe burning and electricity sensation in both feet was diagnosed (MRI) with two MNs (2–3 and 3–4 interspaces) in each foot leading to walking difficulties. Analgesics and repeated local injections led to partial and only temporary relief. Ultrasound-guided PRFs were performed (42°C ; 420 seconds) on both feet in November 2009.
Results PRF led to a dramatic decrease in pain (VAS dropped from 9–10/10 to 0/10) and walking was no-longer impaired. The right foot remained pain free for about 10 years. Recurrence of moderate pain in the left foot 18 months after the first procedure led to repeated x-ray guided PRF in one inter-space, with no residual pain over additional 8 years. No complications were reported during the entire follow-up period.
Conclusions Although by unclear mechanisms, PRF may provide long-term, about 10 years, adequate and safe pain relief and improve disability in patients with MN related pain. Clinical trials are indicated for validation of this preliminary observation.
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