Lizano-Díez Xavier, Ginés-Cespedosa Alberto, Alentorn-Geli Eduard, Pérez-Prieto Daniel, González-Lucena Gemma, Gamba Carlo, de Zabala Santiago, Solano-López Alberto, Rigol-Ramón Pau
1 Department of Orthopaedic Surgery, Parc de Salut Mar, Hospital del Mar i l'Esperança, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
2 Fundación García-Cugat, Barcelona, Spain.
Foot Ankle Int. 2017 Sep;38(9):944-951. doi: 10.1177/1071100717709569. Epub 2017 Jun 15.
The effectiveness of corticosteroid injection for the treatment of Morton's neuroma is unclear. In addition, most of the studies related to it are case-control or retrospective case series. The purpose of this study was to compare the effectiveness between corticosteroid injection associated with local anesthetic and local anesthetic alone (placebo control group) for the treatment of Morton's neuroma.
Forty-one patients with a diagnosis of Morton's neuroma were randomized to receive 3 injections of either a corticosteroid plus a local anesthetic or a local anesthetic alone. The patients and the researcher who collected data were blinded to the treatment groups. The visual analog scale for pain and the American Orthopaedic Foot & Ankle Score (metatarsophalangeal/interphalangeal score) were obtained at baseline, after each injection, and at 3 and 6 months after the last injection.
There were no significant between-group differences in terms of pain and function improvement at 3 and 6 months after treatment completion in comparison with baseline values. At the end of the study, 17 (48.5%) patients requested surgical excision of the neuroma: 7 (44%) in the experimental group and 10 (53%) in the control group ( P = 1.0).
The injection of a corticosteroid plus a local anesthetic was not superior to a local anesthetic alone in terms of pain and function improvement in patients with Morton's neuroma.
Level I, randomized controlled trial.
皮质类固醇注射治疗莫顿神经瘤的有效性尚不清楚。此外，与之相关的大多数研究都是病例对照或回顾性病例系列研究。本研究的目的是比较皮质类固醇联合局部麻醉剂注射与单纯局部麻醉剂（安慰剂对照组）治疗莫顿神经瘤的有效性。
41例诊断为莫顿神经瘤的患者被随机分为两组，分别接受3次皮质类固醇加局部麻醉剂注射或单纯局部麻醉剂注射。患者和收集数据的研究人员对治疗组情况不知情。在基线、每次注射后以及最后一次注射后3个月和6个月时，采用视觉模拟疼痛量表和美国矫形足踝评分（跖趾关节/趾间关节评分）进行评估。
与基线值相比，治疗完成后3个月和6个月时，两组在疼痛和功能改善方面无显著组间差异。在研究结束时，17例（48.5%）患者要求手术切除神经瘤：试验组7例（44%），对照组10例（53%）（P = 1.0）。
在改善莫顿神经瘤患者的疼痛和功能方面，皮质类固醇联合局部麻醉剂注射并不优于单纯局部麻醉剂注射。
I级，随机对照试验。
