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Morton’s neuroma RFA

What Is Morton’s Neuroma Radiofrequency Ablation?

A Morton’s neuroma is frequently considered to be a result of repetitive compression upon the common plantar digital nerve most frequently involving the third web space of the forefoot, and less commonly the second web space. Whatever the underlying aetiology may be; the end result is “perineural fibrosis of the common plantar digital nerve”. This leads to swelling of the digital nerve and the reproduction of a severe intermittent pain to the toes, especially during the toe – off phase of walking and running.

 

Radiofrequency ablation is particularly effective in patients that have not had complete relief with conservative treatment including biomechanical optimisation and orthotics. It is also useful in patients who have undergone surgical neurectomy or ethanol neurolysis, and have ongoing symptoms of neuroma.

 

Procedure Details

Radiofrequency ablation (RFA) is a minimally invasive treatment for Morton’s neuroma. RFA is performed by one of our interventional radiologists under ultrasound guidance with local anaesthetic and takes 15 minutes to perform. The radiofrequency needle heats the tissue in the neuroma changing the protein structure of the cells and thereby reducing pain signals.

The electrode tip reaches 85°C and is repositioned by our radiologist at three areas in the neuroma during the ultrasound guided procedure.

Post procedure

It is recommended that you rest for 48 hours after the RFA injection to limit the degree of localised pain. It is beneficial to elevate the foot and apply ice packs for 20 minutes each two hours during the first 24 hours. If there is significant discomfort, you may require simple analgesic medication such as Panadol or anti-inflammatory medication e.g. Voltaren.

Procedure Risks

The procedure risks are infrequent, however there is a small chance of worsened pain, or no significant improvement of pain, infection at the injection site, localised bruising and nerve damage with loss of sensation are potential risks. Some patients do report having increased swelling, redness and pain for all up to 2 weeks after the RFA. In most cases this gradually improves and there is an overall improvement within three months.

The radiofrequency ablation treatment, whilst effective in approximately 80% of patients, may be ineffective in up to 20% of patients. These patients can still undergo surgical excision if required.