A Systematic Review of Ultrasound-Guided and Non Ultrasound-Guided Therapeutic Injections to treat Morton's neuroma.

Abstract BACKGROUND:Morton's neuroma is a frequently painful condition of the forefoot, causing sufferers to seek medical care to alleviate symptoms. A plethora of therapeutic options are available, some of which include injection therapies. Researchers have investigated injection therapy for Morton's neuroma, and latterly the evidence base has been augmented with methodologies which utilise diagnostic ultrasound (US) as a vehicle to deliver the injectate under image guidance for additional accuracy. There appears to date to be no consensus that US-guided injections provide better therapeutic outcomes than non US-guided (blind) injections for treatment of Morton's neuroma. METHODS:A systematic review was chosen, as this methodology can undertake such a process. The review process identified 13 key papers using pre-determined inclusion and exclusion criteria, which then underwent methodological quality assessment using a pre-tested Quality Index. A narrative synthesis of the review findings was presented in light of the heterogeneity of the data from the extraction process. RESULTS:This systematic review provides an argument that ultrasound-guidance can produce better short- and long-term pain relief for corticosteroid injections, can reduce the need for additional procedures in a series of sclerosing alcohol injections, can reduce the surgical referral rate, and adds efficacy to a single injection.

CONCLUSIONS: Ultrasound guidance should be considered for injection therapy in the management of Morton's neuroma.