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Table 2 Characteristics of included studies

From: The effectiveness of non-surgical interventions for common plantar digital compressive neuropathy (Morton’s neuroma): a systematic review and meta-analysis

Study ID Sample Size Female/Male Age (years) Mean, Range Inclusion Criteria Intervention Study Duration Outcome Measure
Bennett 1995 [4] 115, 99/16 48.0, 18–79 Clinical Wider, properly fitted footwear and a metatarsal pad proximal to the inflamed nerve 3 months Satisfaction
Cashley 2015 [2] 38, 23/15 NR Mulder’s sign, and positive digital nerve stretch test Manipulation of the MTPJ (Distraction and plantarflexion of the MTPJ) 1/week × 4 weeks and 1 per 2 weeks × 2 (total = 6 treatments) 8 weeks VAS (0–100)
Pain pressure threshold
Cazzato 2016 [51] 20, 15/5 50.3, 24–67 Symptoms and US and MRI 1 x MRI guided cryoablation (00 × 150 s)
Some received additional cryoablation for 90 s but details NR
Mean 19.7 (1–50) months VAS (0–10)
Johnson scale
Chuter 2013 [10] 25, 21/4 55.0, 33–73 US Mean 1.6 (1–3) x US guided radiofrequency ablation
(810, 5 × 2 min)
4 weeks apart
6 months VAS (0–10)
Climent 2013 [6] 17, 7/10 58.2, SD 2.6 MRI or US 1 x Botox injection
(50 units of onabotulinumtoxinA dissolved in 0.5 ml of normal saline)
3 months VAS (0–10)
FHSQ (foot pain, foot function, footwear, foot health)
Deniz 2015 [9] 20, 16/4 48.4, 21–67 Clinical and US 1 x US guided pulsed radiofrequency ablation (420 × 5 min) Mean 9 (7–15) months Satisfaction
Comfort when walking
VAS (0–10)
Dockery 1999 [5] 100, 73/27 51.0, 20–75 Clinical but not specified 3–7 x alcohol and anaesthetic injection
(0.5 ml of 4% sclerosing solution consisting of 48 ml of 0.5% bupivacaine HCI with epinephrine (1:200,000) and 2 ml of ethyl alcohol 98%)
repeated at 5–10 day intervals
Mean 13 (6–24) months Improvement
Fanucci 2003 [20] 40, 33/7 48.0, 28–65 Clinical and US 4 x US guided alcohol and anaesthetic injections
(0.35 ml carbocaine and 0.15 ml ethylic alcohol 95%)
15 days apart
10 months Johnson scale
Friedman 2012 [49] 5, 5/0 55.0, 47–60 US 1 x US guided cryoneurolysis
(− 750, 1–3 freeze/thaw ×  2–3 min cycles)
Mean 16 (4–56) months Treatment response
Govender 2007 [48] 20, NR, VS
20, NR
Split for combined 10:3
50.0, NR, VS
53.0, NR
Range for combined 23–79
Symptoms or clinical findings Manipulation and mobilisation of foot and ankle joints
(6 different techniques which may include distraction and plantarflexion of the MTPJ) AND 5 min detuned US
2/week ×  3 weeks (total = 6 treatments)
VS 5 min detuned US
3 weeks VAS (0–100)
Short-form McGill Pain Questionnaire
Foot Function Index - Pain
Foot Function Index - Disability
Pain pressure threshold
Pain pressure tolerance
Hassouna 2007 [22] 39, 32/7 55.8, 26–83 Clinical and US 1 x US guided steroid and anaesthetic injection (mixture of 2 ml 0.5% bupivacaine and 20 mg of triamcinolone acetonide) Mean 11.4 (range NR) months Activity restriction
Footwear requirements
Johnson scale
Hughes 2007 [7] 101, 84/17 53.8, 30–74 Clinical and US 4 x US guided alcohol and anaesthetic injections
(0.1 ml ethyl alcohol 100% and 0.4 ml bupivacaine 0.25%)
14 days apart
4 additional injections provided to unknown number of subjects
Mean 10.5 (7–19) months Johnson scale – modified
VAS (0–10)
Hyer 2005 [19] 6, 4/2 61.7, 50–81 Clinical 3–9 x alcohol and anaesthetic injection
(0.5 ml of 4% sclerosing solution consisting of 48 ml of 0.5% bupivacaine HCI with epinephrine (1:200,000) and 2 ml of ethyl alcohol 98%)
weekly injections
Mean 346, SD 50.3 days VAS (0–10)
Kilmartin 1994 [50] 10, NR, VS
11, NR Combined 19/2
40.0, SD 12.0 VS
46.0, SD 10.5
Clinical Varus foot wedge made of 7 mm hard compressed felt on the under surface of a fibreboard inner to supinate the rearfoot and fitted into the subject’s shoes (low heeled lace-up or loose fitting slip on shoes). Felt was replaced at 4, 8 and 12 weeks.
VS
Valgus wedge to pronate the rearfoot
12 months VAS (0–10)
Lizano-Diez 2017 [41] 16, 12/4 VS
19, 17/2
57.7, SD 9.8 VS
60.7, SD 11.6
Clinical, Mulder’s sign and MRI 1 x corticosteroid and anaesthetic injection (1 ml triamcinolone 40 mg and 1 ml mepivacaine 2%) 1/week for 3 weeks
VS 1 x anaesthetic injection (2 ml mepivacaine 2%) 1/week for 3 weeks
6 months VAS (0–100)
AOFAS
Johnson scale - modified
Magnan 2005 [23] 65, 55/10 51.5, 19–80 Clinical 1 or 2 electrostimulation guided alcohol and anaesthetic injections
(2.5 ml phenol 5% water solution followed by 3 ml carbocaine 2%)
(19 ft received 2nd injection within 3 months)
Mean 36 (24–55) months VAS (effective / ineffective)
Mahadevan 2016 [40] 23, NR VS
22, NR
57.1, SD 11.7 VS
58.6 SD 14.3
Clinical and positive web space squeeze test and US 1 x US guided corticosteroid and anaesthetic injection (1 ml triamcinolone acetonide 40 mg and 2 ml lignocaine 1%)
VS
1 x corticosteroid and anaesthetic injection (1 ml triamcinolone acetonide 40 mg and 2 ml lignocaine 1%)
12 months VAS (0–100)
Manchester-Oxford Foot Questionnaire Index
Johnson scale
Markovic 2008 [1] 35, 28/7 54.0, 29–77 Symptoms and US 1 x US guided corticosteroid and anaesthetic injection
(1 ml celestone chronodose 5.7 mg and 0.5 ml lidocaine 1%)
9 months Johnson scale
Lower extremity functional scale
Masala 2018 [53] 52, 46/6 53.0, 33–75 Symptoms and US and MRI 1 x US guided continuous radiofrequency ablation (850 × 90 s) 12 months VAS (0–10)
FHSQ
Park 2017 [54] 201, 158/43 55.9, 23–80 Symptoms and Mulder’s sign and US 1 x US guided corticosteroid and anaesthetic (1 ml dexamethasone 5 mg and 1 ml lidocaine 1%) 6 months VAS (0–10)
Johnson scale
Pasquali 2015 [8] 508, 464/44 57.0, 29–81 Symptoms, clinical and US Mean 3 (1–4) x US guided alcohol injection
(0.3 ml ethyl alcohol 95% and 0.3 ml of mepivacaine 2%)
2 weeks apart then 4 weeks apart for 3rd and 4th injections
12 months Satisfaction
VAS (0–10)
Perini 2016 [55] 220, 187/33 55.8, 19–82 Clinical and US 1 x US guided alcohol and anaesthetic injection (0.6–1.0 ml of 50% absolute alcohol and 50% lidocaine 2%) every 2nd week for a median of 3 treatments (IQR 3–3) Mean 19 (15–24) months VAS (0–10)
Saygi 2005 [3] 35, 31/4 VS
34, 29/5
52.0, SD 11.8 VS
51.9, SD 11.0
Clinical and US Shoes with wide toe boxes and low heels and metatarsal pad
(custom fitted inserts)
VS
2 x corticosteroid and anaesthetic injection
(1 ml methylprednisolone acetate 40 mg and 1 ml prilocaine 4%)
3 weeks apart
6 months Satisfaction
Seok 2016 [52] 14, 9/5 VS
12, 8/4
58.5, SD 13.4
VS
54.5, SD 14.3
Symptoms, Mulder’s sign and US 1 x ESWT (1000 shocks at 3 Hz) with energy level set to maximum patient tolerance (0.12–0.24 mJ/mm2)
VS
1 x ESWT with probe perpendicular to energy delivery and energy level set to 0.03mJ/mm2
4 weeks VAS (0–100)
AOFAS
Johnson scale
Thomson 2013 [39] 64, 54/10 VS
67, 57/10
54.7, SD 17.4
VS
51.6, SD 12.9
Symptoms and US 1 x US guided corticosteroid and anaesthetic injection
(1 ml methylprednisolone 40 mg and 1 ml lignocaine 2%)
VS
1 x US guided anaesthetic injection
(1 ml lignocaine 2%)
3 months Foot health thermometer
VAS (0–100)
MFPDI – pain
MFPDI – walking
MFPDI – work
  1. NR Not reported, MTPJ Metatarsophalangeal joint, VAS Visual analogue scale, US Ultrasound, MRI Magnetic resonance imaging, s Second, min Minute, SD Standard deviation, FHSQ Foot health status questionnaire, ml Millilitres, VS Verses, mg Microgram, mm Millimetre, IQR Interquartile range, ESWT Extracorporeal shockwave therapy, Hz Hertz, mJ millijoules, AOFAS American Orthopaedic Foot and Ankle Score, MFPDI Manchester Foot Pain and Disability Index