Department of Trauma and Orthopaedics, Whipps Cross University Hospital, Leytonstone, E11 1NR, UK.
Foot Ankle Int. 2012 Sep;33(9):722-6. doi: 10.3113/FAI.2012.0722.
The aim of this prospective study was to assess the effectiveness of a single ultrasound-guided steroid injection in the treatment of Morton's neuromas and whether the response to injection correlates with the size of the neuroma.
Forty-three patients with clinical features of Morton's neuroma underwent ultrasound scan assessment. Once the lesion was confirmed in the relevant web space, a single corticosteroid injection was given using 40 mg of methylprednisolone along with 1% lidocaine. All scans and injections were performed by a single musculoskeletal radiologist. Patients were divided into two groups on the basis of the size of the lesion measured on the scan. Group 1 included patients with neuromas of 5 mm or less and group 2 patients had neuromas larger than 5 mm. A visual analog scale (VAS) for pain (scale 0 to 10), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Johnson satisfaction scale were used to assess patients before injection and then at 6 weeks, 6 months, and 12 months following the injection. Thirty-nine patients had confirmed neuromas. Group 1 (lesion ≤ 5 mm) included 17 patients (mean age, 30 years) (7 males, 10 females) and group 2 (lesion >5 mm) had 22 patients (mean age, 33 years) (8 males, 14 females).
VAS scores, AOFAS scores, and Johnson scale improved significantly in both groups at 6 weeks (p < .0001). At 6 months postinjection, this improvement remained significant only in group 1 with all scores (p < . 001). At 12 months, there was no difference between both groups and outcome scores nearly approached preinjection scores. At the final review, two patients in group 1 and four patients in group 2 had severe recurrent symptoms and therefore underwent surgical excision of the neuroma after they rejected the offer for a repeat injection (p = 0.6).
A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.
本前瞻性研究旨在评估单次超声引导下类固醇注射治疗 Morton 神经瘤的疗效，以及注射反应是否与神经瘤的大小相关。
43 例临床疑似 Morton 神经瘤的患者接受了超声扫描评估。一旦在相关的间隔内确认病变，就在超声引导下注射 40mg 甲泼尼龙和 1%利多卡因的混合物。所有扫描和注射均由一位肌肉骨骼放射科医生完成。根据扫描测量的病变大小，患者被分为两组。组 1 包括神经瘤大小为 5mm 或以下的患者，组 2 包括神经瘤大小大于 5mm 的患者。使用疼痛视觉模拟量表（VAS，0-10 分）、美国矫形足踝协会（AOFAS）评分和 Johnson 满意度量表在注射前以及注射后 6 周、6 个月和 12 个月对患者进行评估。39 例患者有确诊的神经瘤。组 1（病变≤5mm）包括 17 例患者（平均年龄 30 岁）（男性 7 例，女性 10 例），组 2（病变>5mm）包括 22 例患者（平均年龄 33 岁）（男性 8 例，女性 14 例）。
两组患者在注射后 6 周时 VAS 评分、AOFAS 评分和 Johnson 量表均显著改善（p<0.0001）。在注射后 6 个月时，仅组 1 的所有评分仍保持显著改善（p<0.001）。在 12 个月时，两组之间没有差异，并且结果评分几乎接近注射前的评分。在最终复查时，组 1 中有 2 例患者和组 2 中有 4 例患者出现严重的复发性症状，因此在拒绝重复注射的情况下接受了神经瘤切除术（p=0.6）。
单次超声引导下皮质类固醇注射可缓解症状性 Morton 神经瘤的短期疼痛。对于小于 5mm 的病变，注射的效果更为显著且持久。
