Department of Physical Medicine and Rehabilitation, Hospital General Universitario, Maestro Alonso 109, 03010, Alicante, Spain.
Clin Drug Investig. 2013 Jul;33(7):497-503. doi: 10.1007/s40261-013-0090-0.
Morton neuroma is a common cause of metatarsalgia of neuropathic origin. Systematic reviews suggest that insufficient studies have been performed on the efficacy of the different treatments available. OnabotulinumtoxinA has shown a degree of usefulness in other conditions associated with neuropathic pain. The aim of this study was to investigate the therapeutic potential of onabotulinumtoxinA in Morton neuroma.
We present an open-label, pilot study with 17 consecutive patients with Morton neuroma and pain of more than 3 months' duration that had not responded to conservative treatment with physical measures or corticosteroid injection. Patients received one onabotulinumtoxinA injection in the area of the neuroma. The main outcome measure was the variation in the pain on walking evaluated using a visual analogue scale (VAS) before treatment and at 1 and 3 months after treatment. The secondary outcome was the change in foot function, which was assessed using the Foot Health Status Questionnaire.
In the overall group, the mean initial VAS score on walking was 7. This mean score had fallen to 4.8 at 1 month after treatment and to 3.7 at 3 months. Twelve patients (70.6 %) reported an improvement in their pain and five patients (29.4 %) reported no change; exacerbation of the pain did not occur in any patient. Improvements were also observed in two of the dimensions of the Foot Health Status Questionnaire: foot pain, which improved from a mean of 38.88 before treatment to 57 at 3 months, and foot function, which improved from a mean of 42.27 before treatment to 59.9 at 3 months. Clinical variables including age, sex, site and size of the lesion, standing activity, weekly duration of walking, footwear, foot type and footprint had no influence on the outcome. No adverse effects were reported.
In this pilot study, injection with onabotulinumtoxinA was shown to be of possible usefulness to relieve the pain and improve function in Morton neuroma. This finding opens the door to further clinical research.
莫顿神经瘤是一种常见的神经源性跖痛症病因。系统评价表明，对于现有治疗方法的疗效，相关研究还不够充分。肉毒毒素 A 已在其他与神经病理性疼痛相关的疾病中显示出一定的有效性。本研究旨在探讨肉毒毒素 A 治疗莫顿神经瘤的潜力。
我们进行了一项开放性、初步研究，共纳入 17 例连续的莫顿神经瘤患者，这些患者的疼痛持续时间超过 3 个月，且经物理治疗或皮质类固醇注射等保守治疗后无效。患者在神经瘤区域接受一次肉毒毒素 A 注射。主要观察指标是治疗前、治疗后 1 个月和 3 个月时用视觉模拟量表（VAS）评估的行走时疼痛变化。次要观察指标是使用足部健康状况调查问卷评估的足部功能变化。
总体而言，初始行走时 VAS 平均评分为 7 分，治疗 1 个月后降至 4.8 分，3 个月后降至 3.7 分。12 例（70.6%）患者报告疼痛改善，5 例（29.4%）患者报告无变化，无患者出现疼痛加重。足部健康状况调查问卷的两个维度也有改善：足部疼痛，从治疗前的平均 38.88 分改善至 3 个月时的 57 分；足部功能，从治疗前的平均 42.27 分改善至 3 个月时的 59.9 分。包括年龄、性别、病变部位和大小、站立活动、每周行走时间、鞋类、足型和足印在内的临床变量对结果均无影响。未报告不良反应。
在本初步研究中，肉毒毒素 A 注射显示出缓解莫顿神经瘤疼痛和改善功能的可能用途。这一发现为进一步的临床研究开辟了道路。
