There is insufficient evidence from randomised controlled trials to assess efficacy of surgical and non-surgical interventions for Morton's neuroma. More research is needed.

Thomson CE, Gibson JA, Martin D

Published Online:

April 13, 2011

Morton's neuroma is a common, painful condition affecting the web spaces of the toes. Limited evidence from one randomised controlled trial indicated that surgery involving cutting the relevant nerve and implanting it into a muscle tendon may yield better long-term results than standard surgical removal of the nerve. There is little evidence from randomised controlled trials to support the use of insoles. There were no randomised controlled trials reporting the effect of corticosteroid injections. Adverse events following surgery were common. Well-designed trials are needed to guide clinical practice.

Abstract (click to read)

Background:

Morton's neuroma is a common, paroxysmal neuralgia affecting the web spaces of the toes, typically the third. The pain is often so debilitating that patients become anxious about walking or even putting their foot to the ground. Insoles, corticosteroid injections, excision of the nerve, transposition of the nerve and neurolysis of the nerve are commonly used treatments. Their effectiveness is poorly understood.

Objectives:

To examine the evidence from randomised controlled trials concerning the effectiveness of interventions in adults with Morton's neuroma.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group trials register (searched January 2003), MEDLINE (January 1966 to January Week 2 2003), EMBASE (January 1980 to February Week 2 2003), and CINAHL (January 1982 to February Week 1 2003).

Selection criteria:

Randomised or quasi-randomised (methods of allocating participants to an intervention which were not strictly random e.g. date of birth, hospital record, number alternation) controlled trials of interventions for Morton's neuroma were selected. Studies where participants were not randomised into intervention groups were excluded.

Data collection and analysis:

Two reviewers selected trials for inclusion in the review, assessed their methodological quality and extracted data independently.

Main results:

Three trials involving 121 people were included. There is, at most, a very limited indication that transposition of the transected plantar digital nerve may yield better results than standard resection of the nerve in the long term. There is no evidence to support the use of supinatory insoles. There are, at best, very limited indications to suggest that dorsal incisions for resection of the plantar digital nerve may result in less symptomatic post-operative scars when compared to plantar excision of the nerve.

Authors' conclusions:

There is insufficient evidence with which to assess the effectiveness of surgical and non-surgical interventions for Morton's neuroma. Well designed trials are needed to begin to establish an evidence base for the treatment of Morton's neuroma pain.

This record should be cited as:

Thomson CE, Gibson JA, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003118. DOI: 10.1002/14651858.CD003118.pub2

Assessed as up to date:

April 14, 2004

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Primary Review Group:

Neuromuscular Disease Group

Health topics:

Neurology > Peripheral neuropathy > Entrapment neuropathy

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

There is insufficient evidence from randomised controlled trials to assess efficacy of surgical and non-surgical interventions for Morton's neuroma. More research is needed.

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