Optimizing Management of Morton’s Neuroma: Extracorporeal Shock Wave Therapy in Clinical Practice

Morton's neuroma (MN) is frequently refractory to conventional conservative therapies, and surgical excision carries the risk of recurrent pain. While extracorporeal shock wave therapy (ESWT) has emerged as a potential non-invasive intervention for MN, a standardized clinical protocol for its application remains to be established. This review aims to elucidate the physiological validity of ESWT for MN and propose an optimized clinical protocol. Existing randomized controlled trials of ESWT for MN were analyzed, and findings from other entrapment neuropathies were extrapolated to critically appraise interventional factors influencing therapeutic outcomes. ESWT exerts a biphasic effect: immediate analgesia via the degeneration of free nerve endings, and radical pathophysiological improvement through the promotion of neovascularization and tissue repair. The present analysis suggests that the use of local anesthesia may inhibit mechanotransduction, potentially reducing success rates. Furthermore, considering the dynamics of growth factors involved in tissue regeneration, multiple sessions at one-week intervals are more rational than a single application. Optimizing ESWT through repetitive sessions without anesthesia at the maximum tolerable energy flux density may maximize therapeutic efficacy. ESWT is expected to become an integral, minimally invasive standard therapy that precludes the necessity for surgical intervention.