Aims A local injection may be used as an early option in the treatment of Morton's neuroma, and can be performed using various medications. The aim of this study was to compare the effects of injections of hyaluronic acid compared with corticosteroid in the treatment of this condition. Methods A total of 91 patients were assessed for this trial, of whom 45 were subsequently included and randomized into two groups. One patient was lost to follow-up, leaving 22 patients (24 feet) in each group. The patients in the hyaluronic acid group were treated with three ultrasound-guided injections (one per week) of hyaluronic acid (Osteonil Plus). Those in the corticosteroid group were treated with three ultrasound-guided injections (also one per week) of triamcinolone (Triancil). The patients were evaluated before treatment and at one, three, six, and 12 months after treatment. The primary outcome measure was the visual analogue scale for pain (VAS). Secondary outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complications. Results Both groups showed significant improvement in VAS and AOFAS scores (p < 0.05) after 12 months. The corticosteroid group had a significantly greater reduction in VAS and increase in AOFAS scores compared with the hyaluronic acid group, at one, three, and six months, but with no significant difference at 12 months. There were no complications in the hyaluronic acid group. There were minor local complications in six patients (six feet) (25.0%) in the corticosteroid group, all with discolouration of the skin at the site of the injection. These minor complications might have been due to the three weekly injections of a relatively high dose of corticosteroid. No patient subsequently underwent excision of the neuroma. Conclusion An ultrasound-guided corticosteroid injection showed statistically significantly better functional and pain outcomes than an ultrasound-guided injection of hyaluronic acid for the treatment of a Morton's neuroma at many timepoints. Thus, a corticosteroid injection should be regarded as a primary option in the treatment of these patients, and the only indication for an injection of hyaluronic acid might be in patients in whom corticosteroid is contraindicated.

中文翻译：

---

超声引导下透明质酸浸润与皮质类固醇治疗莫顿神经瘤的比较。


目的 局部注射可用作治疗莫顿神经瘤的早期选择，并且可以使用各种药物进行。本研究的目的是比较注射透明质酸与皮质类固醇治疗这种情况的效果。方法 本试验共评估了 91 例患者，其中 45 例随后被纳入并随机分为两组。1 名患者失访，每组剩下 22 名患者 （24 英尺）。透明质酸组患者接受 3 次超声引导下注射透明质酸 （每周 1 次） （Osteonil Plus） 治疗。皮质类固醇组的患者接受 3 次超声引导下注射曲安奈德 （Triancil） 治疗 （也是每周 1 次）。患者在治疗前和治疗后 1 、 3 、 6 和 12 个月进行评估。主要结局指标是疼痛视觉模拟量表 （VAS）。次要结局指标包括美国骨科足踝协会 （AOFAS） 评分和并发症。结果 12 个月后，两组的 VAS 和 AOFAS 评分均有显著改善 （p < 0.05）。与透明质酸组相比，皮质类固醇组在 1 个月、3 个月和 6 个月时 VAS 降低幅度显著增加，AOFAS 评分增加幅度更大，但在 12 个月时差异不显著。透明质酸组没有并发症。皮质类固醇组有 6 名患者 （6 英尺） （25.0%） 出现轻微的局部并发症，均伴有注射部位皮肤变色。这些轻微的并发症可能是由于每周注射相对高剂量的皮质类固醇所致。 没有患者随后接受了神经瘤切除术。结论 超声引导下皮质类固醇注射在许多时间点上显示比超声引导下注射透明质酸治疗莫顿神经瘤的功能和疼痛结局具有统计学意义。因此，皮质类固醇注射应被视为治疗这些患者的主要选择，注射透明质酸的唯一适应症可能是皮质类固醇禁忌证的患者。