Background and Objectives: Morton’s neuroma is a painful foot condition that can be treated with continuous radiofrequency. However, its efficacy is not always optimal, with failure rates of 15–20%. It has been suggested that these failures may be due to incomplete nerve ablation, allowing for nerve regeneration and persistent pain. So, the aim of this study was to assess the histological effects of continuous radiofrequency on the nerves affected by Morton’s neuroma. Materials and Methods: The effect of continuous radiofrequency was evaluated in two patients with Morton’s neuroma, which required open surgery excision. In both cases, radiofrequency with a standard protocol was applied ex vivo, following the surgical excision of the neuroma. A TLG10 RF generator (90 °C, 90 s) with a monopolar needle with a 0.5 cm active tip was used. Subsequently, the samples were histologically analyzed to determine the degree of nerve ablation. Results: Histological analysis showed homogeneous focal necrosis in both cases, with lesion depths of 2.4 mm and 3.18 mm. However, areas of intact nerve tissue were identified at the periphery of the neuroma, suggesting incomplete ablation. Conclusions: The findings indicate that continuous radiofrequency does not guarantee total nerve ablation, which could explain recurrence in some cases. Intraoperative neurophysiological monitoring could be key to optimizing the procedure, ensuring complete interruption of nerve conduction and improving treatment efficacy.

Background/Objectives: The tibial nerve, commonly misnamed the “posterior tibial nerve”, branches into four key nerves: the medial plantar, lateral plantar, inferior calcaneal (Baxter’s nerve), and medial calcaneal branches. These nerves are integral to both the sensory and motor functions of the foot. Approximately 15% of adults with foot issues experience heel pain, frequently stemming from neural origins, such as tarsal tunnel syndrome (TTS). TTS diagnosis remains challenging due to a high false negative rate in neurophysiological studies. This study aims to improve the understanding and diagnosis of distal tarsal tunnel pathology to enable more effective treatments, including platelet-rich plasma, hydrodissections, radiofrequencies, and prolotherapy. Methods: Ultrasound-guided techniques were employed to examine the distal tarsal tunnel using the Heimkes triangle for optimal probe placement. Results: The results indicate that the tunnel consists of two chambers separated by the interfascicular septum, housing the medial, lateral plantar, and inferior calcaneal nerves. Successful interventions depend on precise visualization and patient positioning. This study emphasizes the importance of avoiding the calcaneus periosteum to reduce discomfort. Conclusions: Standardizing nerve involvement classification in TTS is difficult without robust neurophysiological studies. The accurate targeting of nerve branches is essential for effective treatment.

Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain, particularly in cases where clinical presentation is complex and diagnostic uncertainty is common. So, the aim of this study was to propose an alternative to the current procedure, which is known to produce a high rate of false positives in suspected cases of Morton’s neuroma. Material and methods: An experimental anatomical study was conducted on six fresh cadaveric feet. Under ultrasound guidance, the second, third, and fourth metatarsophalangeal joints were infiltrated with progressively increasing volumes of radiopaque contrast medium. Additionally, the third common digital nerve was injected in a healthy segment of the nerve within the third intermetatarsal space. Standard radiographs were then obtained to evaluate the distribution and proximal spread of the injected fluid. Results: A volume of 0.3 ml was sufficient to fully reach the intra-articular cavity and induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. Conclusions: Low intra-articular volumes of anesthetic may be sufficient to achieve a targeted clinical response, whereas injection into a Morton’s neuroma leads to a broader proximal spread, potentially anesthetizing adjacent anatomical structures and thus reducing diagnostic specificity. This refined technique may enhance the accuracy of therapeutic decision-making and reduce treatment failures in patients with suspected Morton’s neuroma.

Background and Objectives: Morton's neuroma is a painful foot condition that can be treated with continuous radiofrequency. However, its efficacy is not always optimal, with failure rates of 15-20%. It has been suggested that these failures may be due to incomplete nerve ablation, allowing for nerve regeneration and persistent pain. So, the aim of this study was to assess the histological effects on the nerve of continuous radiofrequency on Morton's neuroma. Materials and Methods: The effect of continuous radiofrequency was evaluated in two patients with Morton's neuroma, which required open surgery excision. In both cases, radiofrequency with an standard protocol was applied ex vivo, following the surgical excision of the neuroma. A Neurotherm NT1100 generator (90°C, 90s) with a monopolar needle with a 0.5 cm active tip was used. Subsequently, the samples were histologically analyzed to determine the degree of nerve ablation. Results: Histological analysis showed homogeneous focal necrosis in both cases, with lesion depths of 2.4 mm and 3.18 mm. However, areas of intact nerve tissue were identified at the periphery of the neuroma, suggesting incomplete ablation. Conclusions: The findings indicate that continuous radiofrequency does not guarantee total nerve ablation, which could explain recurrence in some cases. Intraoperative neurophysiological monitoring could be key to optimizing the procedure, ensuring complete interruption of nerve conduction and improving treatment efficacy.

Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries and containing bursae and the plantar digital nerve, favors diffuse spread. Due to the high rate of false positives in suspected cases of Morton’s neuroma with the anesthetic block current procedure in the intermetatarsal space, the aim of this study was to propose an alternative to the current procedure. Material and Methods: Six fresh cadaveric feet were used. Under ultrasound guidance, the 2nd–4th MTP joints received stepwise intra-articular injections of radiopaque contrast. The third common digital nerve was injected within the third intermetatarsal space. Standard radiographs were obtained to assess distribution and proximal spread. Results: A volume of 0.3 mL was sufficient to fully reach the intra-articular cavity and potentially induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. On radiographs, the intra-articular infiltration lines appear sharply demarcated, supporting the interpretation of the metatarsophalangeal joint as a sealed compartment. Conclusions: Low intra-articular anesthetic volumes may yield targeted effects, while Morton’s neuroma injections spread proximally, risking loss of diagnostic specificity; this technique may improve decision-making accuracy and reduce failures.

Background and Objectives: Morton’s neuroma is a compressive neuropathy of the common plantar digital nerve that most frequently affects the third intermetatarsal space. Continuous radiofrequency (RF) ablation has reported success rates of approximately 80–85%; however, recent histological evidence suggests that RF does not consistently achieve complete neural ablation. This study aimed to evaluate the effectiveness of intraoperative neurophysiological monitoring of sensory nerve action potentials (SNAPs) to optimize the outcomes of continuous RF ablation in the treatment of Morton’s neuroma. Materials and Methods: This prospective case series included 22 patients (30 neuromas) treated with ultrasound-guided continuous RF ablation combined with intraoperative neurophysiological monitoring. SNAPs were recorded before, during, and after each RF application until complete abolition of sensory nerve conduction was confirmed. Clinical outcomes were assessed using the Visual Analog Scale (VAS), the Foot Function Index (FFI), and the Giannini Interdigital Neuroma Clinical Evaluation Score at 3, 6, and 12 months postoperatively. Results: At the 12-month follow-up, satisfactory outcomes (Giannini score ≥60) were achieved in 86.7% of neuromas (26/30). The mean VAS pain score decreased from 8.67 preoperatively to 1.67 at 12 months. Among the seven neuromas with previous unsuccessful RF treatment, all achieved satisfactory outcomes following the monitored procedure. The four cases with poor outcomes were predominantly associated with a positive anesthetic suppression test, suggesting concomitant mechanical metatarsalgia rather than treatment failure. After excluding cases with likely diagnostic misclassification, the adjusted success rate increased to 96.3%. Conclusions: Intraoperative neurophysiological monitoring enables real-time confirmation of complete sensory nerve ablation during continuous RF treatment. Its main potential value appears to lie in patients with previous unsuccessful conventional RF, all of whom achieved satisfactory outcomes in this series. Persistent postoperative symptoms appeared to be more closely related to concomitant forefoot pathology than to technical limitations of the RF procedure.