Methylprednisolone Injections for the Treatment of Morton Neuroma

Thomson, Colin E; Beggs, Ian; Martin, Denis; McMillan, Diane; Edwards, Rhiannon Tudor; Russell, Daphne; Yeo, Seow Tien; Russell, Ian; Gibson, James

doi:10.2106/jbjs.i.01780

Cited by 81 publications

(108 citation statements)

References 21 publications

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“…1). [25][26][27][28][29] Trial, participants, and intervention characteristics (Table 1) All of the studies in the steroid groups involved a single injection of steroid. The median (range) target sample size was 88 (30-131) patients.…”

Section: Search Resultsmentioning

confidence: 99%

“…The studies investigated patients receiving perineural steroids for NP secondary to compression or trauma of various peripheral nerves (common peroneal, suprascapular, popliteal, sciatic, thoracic paravertebral, and femoral nerves), 25 median nerve at the carpal tunnel, 26,29 the ninth (glossopharyngeal) cranial nerve, 28 and interdigital nerves in the foot (Morton's neuroma). 27 A validated scale for diagnosing NP was used in only one study (i.e., the Leeds Assessment of Neuropathic Symptoms and Signs -LANSS), 25 and all other studies enrolled participants only on the basis of neuropathic signs and symptoms.…”

Section: Search Resultsmentioning

confidence: 99%

“…26,29 Three studies had two groups for direct comparison of steroids with LA or CMM. 25,27,28 The other two studies (both on median nerve compression) had three groups. 26,29 In one of these two studies, steroids with and without LA were compared with LA 29 ; whereas, in the other study, steroids were compared with LA in one group and with placebo in another group.…”

Section: Search Resultsmentioning

confidence: 99%

“…26,29 In one of these two studies, steroids with and without LA were compared with LA 29 ; whereas, in the other study, steroids were compared with LA in one group and with placebo in another group. 26 The perineural steroids used in the studies were methylprednisolone (40 mg 27 or 80 mg) 25,28 and triamcinolone (40 mg). 26,29 Local anesthetics used in the comparator groups were lidocaine (0.5% or 2%) 25,27 or procaine (1%).…”

Section: Search Resultsmentioning

confidence: 99%

“…26 The perineural steroids used in the studies were methylprednisolone (40 mg 27 or 80 mg) 25,28 and triamcinolone (40 mg). 26,29 Local anesthetics used in the comparator groups were lidocaine (0.5% or 2%) 25,27 or procaine (1%). 26,29 Prior to perineural injection, the nerves were located using stimulation, 25 ultrasound, 27 or anatomic landmarks.…”

Section: Search Resultsmentioning

confidence: 99%

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Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Bhatia

Flamer

Shah

2015

Can J Anesth/J Can Anesth

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Purpose Perineural steroids are often used to treat chronic peripheral neuropathic pain (NP) secondary to trauma or compression. Nevertheless, when compared with local anesthetics (LA) or conventional medical management (CMM), their efficacy and safety in patients with trauma or compression-related neuropathic pain syndromes is unclear. The purpose of this systematic review and meta-analysis was to determine the efficacy and safety of perineural steroids in compression or traumarelated NP after one to three months of injection. Source We reviewed randomized controlled trials from MEDLINE Ò , EMBASE TM , Cochrane central register of controlled trials, Cochrane database of systematic reviews, and Google Scholar (first 200 hits) up to April 2014 that compared perineural injections of steroids with LA or CMM in adult patients with trauma or compression-related chronic peripheral NP. A meta-analysis was performed on the data on pain scores measured at one to three months after the interventions. Quality of evidence was classified using the GRADE system. Two authors independently reviewed all identified titles and abstracts for eligibility. Principal findings Five trials comprising 353 patients (177 in the steroid group and 176 in the comparator groups) were included. At one to three months after the interventions, patients who received perineural steroids reported lower pain scores than those who received LA or CMM (mean difference: -1.31 points on a 0-10 numerical rating scale for pain; 95% confidence interval: -2.50 to -0.13; quality of evidence: low; I 2 = 89%). None of the studies reported any significant adverse effects.This manuscript was screened for plagiarism using http:// smallseotools.com/plagiarism-checker/.Author contributions Anuj Bhatia wrote the manuscript. Anuj Bhatia and David Flamer participated in the acquisition of data. Anuj Bhatia, David Flamer, and Prakesh S. Shah helped design and conduct the study, and they participated in the conception of the review, the analysis and interpretation of data, and drafting the article. Conclusions Perineural steroids may provide analgesic efficacy for one to three months in patients with chronic peripheral NP of traumatic or compressive origin; however, the strength of this recommendation is weak. Well-designed large randomized studies are required. RésuméObjectif Les infiltrations périnerveuses de stéroïdes sont souvent utilisées pour le traitement de la douleur neuropathique périphérique chronique secondaire à un traumatisme ou une compression. Néanmoins, quand on les compare aux anesthésiques locaux (AL) ou à la prise en charge médicale conventionnelle (PCM), leur efficacité et sécurité chez les patients souffrant de syndromes neuropathiques douloureux secondaires à un traumatisme ou à une compression ne sont pas claires. Les objectifs de cette étude systématique et méta-analyse étaient de déterminer l'efficacité et l'innocuité des infiltrations périnerveuses de stéroïdes dans les neuropathies périphériques liées à une compression ou à un traumatis...

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Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Perineural steroids for trauma and compression-related peripheral neuropathic pain: a systematic review and meta-analysis

Bhatia

Flamer

Shah

2015

Can J Anesth/J Can Anesth

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Common Painful Foot and Ankle Conditions

Cooper

2023

JAMA

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ImportanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are foot and ankle conditions that are associated with pain and disability, but they can respond to nonoperative treatment.ObservationsMorton neuroma, consisting of interdigital neuronal thickening and fibrosis, is characterized by burning pain in the ball of the foot and numbness or burning pain that may radiate to the affected toes (commonly the third and fourth toes). First-line nonoperative therapy consists of reducing activities that cause pain, orthotics, and interdigital corticosteroid injection; however, approximately 30% of patients may not respond to conservative treatment. Plantar fasciitis accounts for more than 1 million patient visits per year in the US and typically presents with plantar heel pain. Fifteen years after diagnosis, approximately 44% of patients continue to have pain. First-line nonoperative therapy includes stretching of the plantar fascia and foot orthotics, followed by extracorporeal shockwave therapy, corticosteroid injection, or platelet-rich plasma injection. Midportion Achilles tendinopathy presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel. The primary nonoperative treatment involves eccentric strengthening exercises, but extracorporeal shockwave therapy may be used.Conclusions and RelevanceMorton neuroma, plantar fasciitis, and Achilles tendinopathy are painful foot and ankle conditions. First-line therapies are activity restriction, orthotics, and corticosteroid injection for Morton neuroma; stretching and foot orthotics for plantar fasciitis; and eccentric strengthening exercises for Achilles tendinopathy.

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