Platelet-Rich Plasma vs Corticosteroid Injection for Morton Neuroma: A Prospective Unblinded Randomized Comparative Study
TL;DR
Findings support further investigation of PRP for symptomatic Morton neuroma and should be interpreted cautiously and considered hypothesis generating pending confirmation in larger, methodologically rigorous studies.
Abstract
Background: Morton neuroma is a common cause of forefoot pain, often refractory to conservative treatment. Corticosteroid injections provide variable and often temporary relief. Platelet-rich plasma (PRP) has emerged as a potential biologic alternative; however, comparative evidence remains limited. Methods: This prospective unblinded randomized comparative study included 60 patients with clinically and magnetic resonance imaging (MRI)–confirmed Morton neuroma treated with either a single corticosteroid injection (n=30) or 3 leukocyte-poor PRP injections (n=30). All patients had failed ≥6 months of conservative treatment. Primary outcomes were PROMIS Physical Function (PF) and Pain Interference (PI) scores at baseline and 3, 6, and 12 months. Secondary outcomes included neuroma size on MRI at 6 months and complications. Results: Baseline characteristics and PROMIS scores were comparable between groups. Both groups demonstrated significant improvement; however, PRP was associated with better outcomes at all time points. At 12 months, PROMIS PF was 61.8 ± 6.2 vs 55.2 ± 6.8 (P < .001), and PROMIS PI was 38.4 ± 6.1 vs 44.2 ± 6.8 (P = .001), favoring PRP. At 6 months, neuroma size was smaller in the PRP group (4.2 ± 1.1 vs 5.8 ± 1.4 mm; P < .001). Complication rates were low and comparable between groups. Post-injection pain rates were comparable between groups; Minor complications occurred only in the corticosteroid group, although differences did not reach statistical significance. Conclusion: PRP was associated with improved clinical outcomes and reduction in neuroma size at 12 months compared with corticosteroid injection. Although these findings support further investigation of PRP for symptomatic Morton neuroma, they should be interpreted cautiously and considered hypothesis generating pending confirmation in larger, methodologically rigorous studies. Level of Evidence: Level II, lesser quality RCT or prospective comparative study.