Efficacy of corticosteroid injection versus size of plantar interdigital neuroma.

BACKGROUND: The aim of this prospective study was to assess the effectiveness of a single ultrasound-guided steroid injection in the treatment of Morton's neuromas and whether the response to injection correlates with the size of the neuroma. METHODS: Forty-three patients with clinical features of Morton's neuroma underwent ultrasound scan assessment. Once the lesion was confirmed in the relevant web space, a single corticosteroid injection was given using 40 mg of methylprednisolone along with 1% lidocaine. All scans and injections were performed by a single musculoskeletal radiologist. Patients were divided into two groups on the basis of the size of the lesion measured on the scan. Group 1 included patients with neuromas of 5 mm or less and group 2 patients had neuromas larger than 5 mm. A visual analog scale (VAS) for pain (scale 0 to 10), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Johnson satisfaction scale were used to assess patients before injection and then at 6 weeks, 6 months, and 12 months following the injection. Thirty-nine patients had confirmed neuromas. Group 1 (lesion ≤ 5 mm) included 17 patients (mean age, 30 years) (7 males, 10 females) and group 2 (lesion >5 mm) had 22 patients (mean age, 33 years) (8 males, 14 females). RESULTS: VAS scores, AOFAS scores, and Johnson scale improved significantly in both groups at 6 weeks (p < .0001). At 6 months postinjection, this improvement remained significant only in group 1 with all scores (p < . 001). At 12 months, there was no difference between both groups and outcome scores nearly approached preinjection scores. At the final review, two patients in group 1 and four patients in group 2 had severe recurrent symptoms and therefore underwent surgical excision of the neuroma after they rejected the offer for a repeat injection (p = 0.6). CONCLUSION: A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.

A comparative study of bone shortening and bone loss with use of saw blades versus burr in hallux valgus surgery.

BACKGROUND: The aim of this study was to assess bone loss and thickness of the cut with the use of a burr in percutaneous hallux valgus surgery. METHODS: Twelve blocks of saw bone were used. Cuts of same depth were made in each block with two different saw blades and a burr. Each block was assessed for bone loss and thickness of the cut. RESULTS: There was statistically significant (p<0.05) increased bone loss and thickness of the cuts with the use of a burr as compared to use of two different saw blades. The use of a burr resulted in threefold increased loss of bone material and fourfold increase in the thickness of the cut as compare to use of two different saw blades. CONCLUSION: The metatarsal shortening is a risk factor in percutaneous hallux valgus surgery with the use of a burr.

The use of a hands-free crutch in patients with musculoskeletal injuries: randomized control trial.

Unilateral musculoskeletal below-knee injuries occur with great frequency. Patients who cannot bear weight on an injured limb usually mobilize themselves with standard crutches. When the patient also has an upper limb injury, however, mobilization might be impossible, and can result in a lengthy in-patient stay. A randomized control trial was conducted on 80 patients to share our experience with the innovative 'hands-free crutch', and to discuss the potential of this device for more frequent use in orthopaedic surgery. We present its value in facilitating early discharge in patients with both upper and lower limb injuries. We show the cost benefit of the decreased in-patient stay that the hands-free crutch provides.