Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 19515
  Title A single-blinded randomized placebo-controlled clinical trial of manipulation and mobilization in the treatment of Morton's neuroma [randomized controlled trial; review]
Journal JACA Online. 2007 Apr;44(3):Online access only p 8-18
Peer Review Yes
Publication Type Randomized Controlled Trial
Abstract/Notes Introduction: A review of the literature has revealed that, of the surgical and (especially) non-surgical randomized controlled trials studied for the treatment of Morton’s neuroma, no sufficient evidence has been found to fully support the effectiveness of any intervention. Since surgery and steroid injections involve risks and complications, a need exists for investigation of the efficacy of alternative conservative therapy. A number of case reports in the literature indicate success using manual manipulation and mobilization procedures of the foot and ankle in the treatment of Morton’s neuroma. This study aimed to analyze the efficacy of these procedures in the form of a randomized controlled trial.

Materials and Methods: This study of 40 subjects compares foot and ankle manipulation and mobilization with placebo (de-tuned ultrasound) in the management of Morton’s neuroma. Outcome measures included the Numerical Pain Rating Scale (NRS)101, a Short-form McGill Pain Questionnaire (SFMPQ), the Foot Function Index - Pain (FFIP) and the Foot Function Index - Disability (FFI-D), Algometer pain pressure threshold, and pain pressure tolerance.

Results: Data were statistically analyzed for significance at a 95% confidence level with alpha (á) set at 0.05. The NRS-101 showed Group B (manipulation and mobilization) to have a statistically significant improvement in perceived pain levels compared with Group A (placebo)at 6 weeks (mean NRS 25.4 and 40.7 respectively, p = 0.03). Algometry pain pressure threshold and tolerance were also found to be statistically significantly improved in Group B compared with Group A (p = 0.02 and p = 0.02 respectively). Power was adequate for the NRS 101 primary outcome measure. No other statistically significant differences in subjective outcome measures (SFMPQ, FFI-P, and FFI-D) were found between the 2 groups.

Discussion: There is evidence that the addition of the manipulative treatment protocol was more efficacious in reducing subjects’ perception of pain, but some limitations do exist.

Conclusion: These findings suggest the possibility of shortterm relief and efficacy for manipulation and mobilization in the treatment of Morton’s neuroma.

This abstract is reproduced with the permission of the publisher. Full text is available by subscription.

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