Radiofrequency Ablation for Morton’s Neuroma
A neuroma is a common foot condition treated by podiatrists. Conservative treatment includes rest, ice, non-steroidal anti-inflammatories, shoe modification, padding to alleviate pressure, orthotics, and injections (corticosteroid or alcohol). Most symptoms resolve, but those that do not may need surgical intervention. Historically, surgery consisted of excision (removal) of the neuroma or decompression of the neuroma by cutting a ligament. Both procedures are effective, but do require significant postoperative recovery. The surgeon may advise non-weightbearing to the operative foot for a period of time and stitches need to be removed. Delayed wound healing, painful scar, infection, and stump neuroma are possible complications. Given this, there is an alternative procedure that can effectively treat a neuroma without the postoperative downtime: radiofrequency ablation.
Radiofrequency ablation (RFA) is a minimally invasive, percutaneous (no incision necessary) procedure to treat painful neuroma symptoms. An electrical current generates heat to destroy the nerve tissue to alleviate pain. It is a same-day, outpatient procedure that requires minimal anesthesia. Prior to the procedure, a mild sedative is given to make the patient comfortable and a small amount of local anesthetic is injected into the area of catheter insertion. Next, the surgeon inserts the catheter (no wider than a needle) to the point of the neuroma; either guided by ultrasound, or he or she may stimulate the nerve to produce the neuroma-like symptoms. Once the neuroma is identified, the procedure begins and the targeted electrical current passes through the catheter to heat the nerve tissue for sixty to ninety seconds. Once complete, the surgeon removes the catheter and may inject local anesthetic and corticosteroid for postoperative swelling and discomfort. A small dressing is applied and can be removed the next day. Postoperatively, RICE (rest, ice, elevation) and non-steroidal anti-inflammatories are recommended. Complications include: bruising, swelling, burns, and infection. RFA may also be used for stump neuromas or recalcitrant neuromas. Overall, the procedure has a high satisfaction rate with patients returning to normal activity and shoes within the first month. Lastly, with any surgical procedure, the surgeon will assess if radiofrequency ablation is the appropriate procedure.
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