Nice | Morton’s neuroma – radiofrequency ablation

This is a new guideline from NICE on treating symptomatic Morton's neuroma with radiofrequency ablation (RFA). They also list current advised management, which I have added at the bottom, as I felt a bit rusty on it.

RFA

RFA is done under LA. A probe is inserted into the webspace and pulses of radiofrequency energy are delivered. This causes thermal ablation of the the nerve. A steroid injection is then given to reduce pain. It can be repeated after a few weeks if needed.

NICE advises that there are no major safety concerns with the treatment, but that there is only limited evidence of its efficacy.

Current Management

Morton's neuroma is caused by perineural fibrosis, which gives scar tissue. This compresses the interdigital nerve, which leads to intermittent pain, a burning sensation and paresthesia in the sole of the foot extending into the toes. It is normally in the webspace between the 3rd and 4th toes, but can be between the 2nd and 3rd toes.

Treatment includes:

  • rest.
  • anti-inflammatories.
  • using an orthosis or modifying footwear.
  • steroid injections.
  • local anaesthetic infections.
  • cryoablation or surgical removal of the nerve for persistent cases).

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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