PONOS · RADIOFREQUENCY · FOOT
Ultrasound-guided radiofrequency for Morton’s neuroma
A targeted percutaneous treatment for forefoot pain, when the diagnosis, local anaesthetic test and clinical assessment support its use.
Book an assessmentExplore the pathwayDr Evangelos Panagiotakos MD · Interventional Pain Medicine · Turin
A neuroma on a scan does not automatically need treatment
An ultrasound or MRI finding is not automatically the source of pain. Treatment decisions depend on agreement between symptoms, clinical examination and investigations.
Symptoms and examination
Burning or electric-shock pain in the forefoot, its location and its relationship to weight-bearing and footwear are assessed. Palpation and provocative manoeuvres, including Mulder’s test where helpful, contribute to the assessment.
Targeted local anaesthetic test
A significant reduction in pain after the block supports the nerve’s contribution. It helps patient selection but does not guarantee the outcome.
Mechanical metatarsalgia, intermetatarsal bursitis and metatarsophalangeal joint conditions should also be considered.
We treat patients, not scans.
The target must be consistent with the patient’s pain and individual goals.
Thermal radiofrequency: a controlled lesion
An electrode is used to produce a thermal lesion in the targeted nerve segment and reduce pain transmission. The neuroma is not surgically removed.
Thermal radiofrequency ablation
This is the procedure described on this page. It requires clinical selection, precise electrode placement and appropriate parameters to protect nearby tissues.
Pulsed radiofrequency
This aims to modulate nerve activity and is not equivalent to thermal ablation. The techniques are not interchangeable: universal superiority or guaranteed effectiveness should not be promised.
The choice depends on the indication, expected benefits, risks and alternatives. How radiofrequency works →
Since 2014: Dr Evangelos Panagiotakos’s technique
Dr Evangelos Panagiotakos has performed ultrasound-guided radiofrequency treatment for Morton’s neuroma since 2014.
His technique uses a single interdigital access, under ultrasound guidance. The choice of access and targeted electrode placement aim to limit trauma to surrounding tissues and minimise the risk of complications, particularly interdigital fibrosis and tendon injury.
In Dr Panagiotakos’s technique, a single interdigital access is combined with carefully controlled, lower temperatures for thermal lesioning of the neuroma, with the aim of limiting heat spread to surrounding tissues and reducing the risk of complications, particularly interdigital fibrosis and tendon injury. This is thermal radiofrequency ablation, distinct from pulsed radiofrequency.
The approach is adapted to the patient’s anatomy and clinical presentation; these measures do not eliminate the risk of complications.
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The PONOS pathway
1 · Diagnosis and previous treatment
Symptoms, investigations, footwear, orthoses and previous conservative treatments are reviewed.
2 · Diagnostic block
When indicated, pain and function are compared before and after a targeted local anaesthetic injection.
3 · Ultrasound-guided procedure
Following sterile preparation and local anaesthesia, the electrode is positioned through a single interdigital access. Ultrasound helps track its path towards the target and identify nearby structures, without X-rays.
4 · Outcome review
Pain while walking, tolerance of footwear and daily activities are reassessed.
Recovery and alternatives
The procedure is percutaneous, without an incision for surgical excision. Early weight-bearing may be possible, but local pain and swelling can require a temporary reduction in activity. Advice is tailored to the individual.
Radiofrequency may be considered after conservative management. Surgery remains an alternative to discuss according to the clinical situation and the patient’s preferences.
Outcomes and safety: realistic expectations
Variable benefit
Studies report improvement in selected patients, but benefit may be incomplete or may not last. Pain relief is not guaranteed.
Risks to discuss
Haematoma, infection, altered sensation, persistent or neuropathic pain and thermal injury to nearby tissues are possible complications. Ultrasound guidance does not remove every risk.
More intensive treatment does not necessarily mean a better result: treatment must be targeted and controlled.
NICE guidance highlights limited evidence of efficacy and calls for particular attention to informed consent and outcome monitoring.
Frequently asked questions
Does a positive local anaesthetic test guarantee success?
No. It helps select the target but cannot reliably predict lasting benefit.
Can I walk straight away?
Early weight-bearing is often possible, following the advice provided. Some limitations may remain over the following days.
Do I need to stop any medication?
Tell us about all medicines, including anticoagulants and antiplatelet drugs. Medication management for radiofrequency is agreed individually; do not stop treatment on your own.
Selected references
- NICE HTG394, formerly IPG539 — Radiofrequency ablation for symptomatic interdigital (Morton’s) neuroma.
- Chuter et al. — Ultrasound-guided radiofrequency ablation in the management of interdigital (Morton’s) neuroma.
Let us assess your forefoot pain
Bring any available investigation reports and a list of treatments you have already tried.
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