Radiofrequency Treatment for Morton’s Neuroma

Morton’s neuroma is a painful condition affecting the ball of the foot, most commonly between the third and fourth toes. It occurs when the tissue around one of the nerves leading to the toes thickens, causing pain and discomfort. This thickening is often due to irritation, pressure, or injury to the nerve. Symptoms include a sharp, burning pain in the ball of the foot, which may radiate to the toes, and a feeling of standing on a pebble in the shoe. The condition predominantly affects middle-aged women and can significantly impact the quality of life due to the pain and discomfort it causes.

Understanding Radiofrequency Treatment for Morton’s Neuroma

Radiofrequency treatment is a minimally invasive procedure that uses electrical energy to generate heat and disrupt nerve function. This technique can be used to treat various chronic pain conditions, including Morton’s neuroma. By targeting the affected nerve with radiofrequency energy, the procedure aims to reduce or eliminate pain by impairing the nerve’s ability to transmit pain signals to the brain.

Mechanism of Action

The principle behind radiofrequency treatment involves the application of radiofrequency waves to heat and damage the nerve tissue. This is achieved through a specialised needle that is inserted near the affected nerve under imaging guidance, such as ultrasound or fluoroscopy. The radiofrequency energy is delivered through the needle, generating heat that causes coagulation and ablation of the nerve tissue. This process disrupts the nerve’s ability to transmit pain signals, thereby providing pain relief.

Types of Radiofrequency Treatment For Morton’s Neuroma

There are two primary types of radiofrequency treatment used in the management of Morton’s neuroma:

Conventional Radiofrequency Ablation (RFA):

• Procedure: Involves the continuous delivery of high-frequency electrical currents to generate heat around the nerve.
• Effect: The heat causes thermal ablation of the nerve, leading to long-term pain relief.
• Application: Generally used for more severe cases where longer-lasting pain relief is required.

Pulsed Radiofrequency (PRF):

• Procedure: Delivers short bursts of radiofrequency energy rather than a continuous flow, resulting in lower temperatures.
• Effect: Causes minimal nerve damage while still modulating pain signals, potentially reducing pain with fewer side effects.
• Application: Often used when a less aggressive treatment approach is desired.

Indications for Radiofrequency Treatment

Radiofrequency treatments for Morton’s neuroma are typically considered when conservative treatments fail to provide adequate relief. These conservative treatments may include:

• Physiotherapy and orthotics to relieve pressure on the affected nerve.
• Anti-inflammatory medications to reduce pain and swelling.
• Corticosteroid injections to alleviate inflammation.
• Changes in footwear to reduce irritation and pressure on the neuroma.
• Calf stretching where a tight muscle / Achilles tendon is contributing

When these measures are insufficient, and the patient continues to experience significant pain and functional impairment, radiofrequency treatment may be recommended.

Procedure Details

The radiofrequency treatment for Morton’s Neuroma typically follows these steps:

Patient Preparation:

• The patient is positioned comfortably, and the foot is cleaned and sterilized.
• Local anesthesia is administered to numb the area around the neuroma.

Needle Insertion:

• Under ultrasound or fluoroscopic guidance, a specialised radiofrequency needle is carefully inserted near the affected nerve.
• Accurate placement is crucial to ensure effective treatment and minimise damage to surrounding tissues.

Radiofrequency Energy Delivery:

• Once the needle is in position, radiofrequency energy is delivered to the nerve.
• For RFA, continuous high-frequency currents generate sufficient heat to ablate the nerve.
• For PRF, bursts of energy create lower temperatures to modulate nerve function without causing significant damage.

Completion:

• The needle is removed, and a small bandage is applied to the insertion site.
• The patient is monitored for a short period before being discharged.

Post-Procedure Care

After the procedure, patients are typically advised to:

• Rest and avoid strenuous activities for a few days.
• Use ice packs to reduce swelling and discomfort at the injection site.
• Follow up with their specialist to monitor progress and address any concerns.

Benefits of Radiofrequency Treatment

Radiofrequency treatments for Morton’s Neuroma offers several advantages over other treatment options:

Minimally Invasive:

• The procedure is performed using a small needle, resulting in minimal tissue damage and quicker recovery times compared to surgical interventions.

Effective Pain Relief:

• Many patients experience significant pain reduction following the procedure, improving their quality of life and ability to perform daily activities.

Long-Lasting Results:

• Especially with RFA, the pain relief can be long-lasting, often extending for several months to years.

Outpatient Procedure:

• The treatment is typically done on an outpatient basis, allowing patients to return home the same day.

Reduced Medication Use:

• Successful radiofrequency treatment can reduce or eliminate the need for ongoing pain medication, minimising potential side effects and dependence.

Risks and Complications

While radiofrequency treatment is generally safe, there are some potential risks and complications, including:

Infection:

• As with any invasive procedure, there is a risk of infection at the needle insertion site.

Nerve Damage:

• There is a small risk of causing unintended damage to nearby nerves, which could result in numbness or weakness in the affected area.

Pain at the Injection Site:

• Some patients may experience temporary pain or discomfort at the site of the needle insertion.

Incomplete Pain Relief:

• In some cases, the procedure may not provide complete pain relief, and additional treatments or interventions (e.g. surgery) may be necessary.

Efficacy and Outcomes

The efficacy of radiofrequency treatment for Morton’s neuroma has been supported by various studies and clinical trials. These studies typically report positive outcomes, with a significant proportion of patients experiencing substantial pain relief. However, the degree of relief can vary based on factors such as the severity of the neuroma, the type of radiofrequency treatment used, and individual patient characteristics.

Clinical Studies:

• Studies have shown that RFA can provide long-term pain relief in a significant percentage of patients with Morton’s neuroma.
• PRF has also been found to be effective, though the duration of pain relief may be shorter compared to RFA.

Patient Satisfaction:

• High levels of patient satisfaction are reported, with many patients experiencing improved function and reduced dependence on pain medications.

Repeat Treatments:

• In cases where pain relief diminishes over time, repeat radiofrequency treatments can be performed to maintain symptom control.

Comparison with Other Treatments

When considering treatments for Morton’s Neuroma, it is essential to compare radiofrequency treatment with other available modalities:

Conservative Treatments:

• While non-invasive and often the first line of management, conservative treatments for Morton’s Neuroma may not provide sufficient relief for all patients.

Corticosteroid Injections:

• These can offer temporary relief but may require repeated injections and carry risks of side effects with prolonged use.

Surgical Excision:

• Surgical removal of the neuroma is a definitive treatment but involves greater risks, including infection, prolonged recovery, and potential complications from anesthesia.

Cryoablation:

• Another minimally invasive technique that uses cold temperatures to destroy nerve tissue. It can be effective but may have a higher risk of incomplete neuroma destruction compared to RFA and takes much longer for benefits to be seen after treatment

Conclusion

Radiofrequency treatment represents a valuable option for managing Morton’s neuroma, particularly in patients who have not responded to conservative treatments. Its minimally invasive nature, combined with its potential for long-lasting pain relief, makes it an attractive alternative to more invasive surgical procedures. By understanding the mechanisms, benefits, risks, and comparative efficacy of radiofrequency treatment, patients and healthcare providers can make informed decisions about the best approach to managing this painful condition.