Systematic Review and Meta-Analysis of Radiofrequency Ablation for Morton's Neuroma: Outcomes and Predictors of Success

Abstract Objective Morton's neuroma presents a challenge in terms of pain management. This study aimed to evaluate the available evidence on the efficacy and safety of radiofrequency ablation for Morton's neuroma. Design PRISMA guidelines were followed. Prospective clinical trials, cohort studies, and case series were also included. Data analysis was performed using Review Manager 5.4. Meta-analysis applied fixed- or random-effects models depending on the heterogeneity. Sensitivity analyses were performed to assess the effects of temperature, radiofrequency cycles, and imaging guidance. Results Eight studies (n = 237) were included. Significant pain reduction was observed at the final follow-up (MD5.74, 95%CI 5.58, 5.90). At the final follow-up, 47.57% (95%CI 25.13%-70.00%) experienced complete pain relief, while 16.40% (95%CI 11.86%-20.94%) reported no benefit at final follow-up. Sensitivity analyses found higher temperature settings (≥85 °C) conferred greater relief on VAS (MD-6.97, 95%CI -6.75 to -7.18) compared to temperatures <85 °C (MD-3.94, 95%CI -3.68 to -4.19). Fewer radiofrequency cycles (≤3) also demonstrated significantly greater VAS improvement (MD-6.97, 95%CI -6.75 to -7.18) versus >3 cycles (MD-4.79, 95%CI -3.02 to -6.57). Complications were minimal (2.1%), and most resolved without significant interventions. Conclusion Radiofrequency ablation, particularly at specific temperatures and cycle thresholds, is effective and safe for the management of Morton’s neuroma.