Manipulation versus steroid injection in the treatment of Morton's neuroma: a randomized control trial.

Abstract

Introduction: Manipulative therapy's rationale is pragmatically appealing as a noninvasive treatment for Morton's Neuroma, involving targeted manipulations of the metatarsophalangeal joints. Nevertheless, manipulation's efficacy has received limited scrutiny.

Method: An exploratory, pragmatic randomized clinical trial was designed to investigate the efficacy of an acute, short dosage (6, weekly episodes) of physiologically principled manipulations, featuring discrete, high-velocity thrusting maneuvers for treating Morton's Neuroma. Adults electing treatment for Morton's Neuroma were randomly allocated to manipulative therapy (n = 29) or corticosteroid injection (n = 32). Baseline and follow-up (at 1.5, 3, 6, 9 and 12 months following treatment cessation) outcome measures of self-reported pain levels; pressure testing for discomfort thresholds; and functionality; pain and social interaction; activities of daily living and sports participation were measured ipsilaterally and by inventory.

Results: Manipulation elicited substantive gains immediately after intervention (visual analog scale for Pain [Cohen's d, 3.3; 84.4%]; pressure threshold testing [d, 2.3; 147.0%]; functionality [d, 1.4; 52.8%]; pain [d, 1.3; 45.5%]; social interaction [d, 0.9; 39.2%]) or accumulated during follow-up (daily living [d, 2.2; 40.8%]; sport [d, 1.5; 66.1%]). Concomitant gains for control participants were modest (d, 0.4 to 1.0; 16.6% to 45.9%) (p < 0.05 to p < 0.0005). Retention of improvements following manipulation cessation was substantial for all metrics, significantly better than baseline scores and consistently exceeded that for corticosteroid injection (p < 0.01 to p < 0.001).

Conclusion: Manipulation elicited significant and clinically relevant improvements and retention in self-reported levels of pain, discomfort and functionality for patients electing treatment for Morton's neuroma.