Randomised controlled trial comparing corticosteroid injection for Morton's neuroma with or without ultrasound guidance - results at 12 months post-intervention

D. Mahadevan, R. Bhatt, M. Attwal, M. Bhatia

Introduction: The objective of this double-blind RCT was to assess whether ultrasound guidance improved the efficacy of corticosteroid injections for Morton's neuroma.

Methods: 50 feet (40 patients) were recruited for this study. 5 cases declined further participation and were excluded. The mean age was 57.8 years with a female preponderance (33F:12M) and patients were followed-up for 12 months. Cases were randomised to receive an ultrasound guided (Group A) or non-ultrasound guided (Group B) injection of 40mg triamcinolone acetonide and 2ml 1% lignocaine.

Results: The mean VAS pain score improved significantly in both groups (Group A - from 64 to 29mm; Group B - from 69 to 37mm) with no statistical difference between them at all time-points. The failure rate within 12 months of treatment was 48% and 55% in Groups A and B respectively (p=0.458). The improvement in MOxFQ-Index and patient satisfaction favoured Group A in the short-term (3 months) that almost reached statistical significance (p=0.059 and 0.066 respectively). However, this difference was not observed beyond 3 months.

Conclusion: This study had shown that US guidance did not demonstrably improve the efficacy of corticosteroid injections in patients with MN.