Luciano Perini1, Claudia Perini2, Matteo Tagliapietra3, Davide Varotto4, Andrea Valcarenghi4, Andrea Postorino4, Antonio Volpe4. 1. Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy. lucipe@libero.it. 2. Department of Gastroenterology, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy. 3. Department of Neurological and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy. 4. Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
Abstract
PURPOSE: To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome. MATERIALS AND METHODS: Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15-24). RESULTS: We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients. CONCLUSIONS: Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.
PURPOSE: To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome. MATERIALS AND METHODS:Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15-24). RESULTS: We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients. CONCLUSIONS: Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.
Authors: James L Thomas; Edwin L Blitch; D Martin Chaney; Kris A Dinucci; Kimberly Eickmeier; Laurence G Rubin; Mickey D Stapp; John V Vanore Journal: J Foot Ankle Surg Date: 2009 Mar-Apr Impact factor: 1.286
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