Radiofrequency Ablation for Nerve Pain in London

Radiofrequency ablation (RFA) uses a fine probe to deliver controlled heat to a small, painful nerve, so that it stops sending pain signals. At LSRI, Dr Prashant Sankaye, Consultant MSK Radiologist, performs RFA under live ultrasound guidance for Morton’s neuroma, other painful neuromas and selected nerve pain from musculoskeletal conditions.

Who radiofrequency ablation may help

• Morton’s neuroma: a thickened, painful nerve between the toes, most often between the third and fourth toes, when footwear changes, insoles or injections have not given lasting relief.
• Other painful neuromas: for example a neuroma that has formed after an injury or an operation.
• Nerve pain from musculoskeletal conditions: selected cases where a small sensory nerve is the main source of long-standing pain in or around a joint or soft tissue.

RFA is not usually the first treatment for any of these. Dr Sankaye first confirms the diagnosis with ultrasound and talks you through all the options, so you can decide together whether RFA is right for you.

How radiofrequency ablation works

In conventional (thermal) RFA, the tip of the probe heats the nerve to around 80 to 90°C for a short time, usually in one to three cycles of about a minute and a half each. This disrupts the nerve so that it can no longer carry pain signals.

In pulsed radiofrequency, the tip stays much cooler, at around 42°C, and delivers short bursts of energy that change how the nerve signals pain without destroying it. The two can also be combined. Dr Sankaye will explain which approach suits your nerve and your symptoms.

Ultrasound lets Dr Sankaye see the nerve and the probe tip in real time, so the treatment is aimed precisely at the painful nerve and nearby structures are avoided.

Radiofrequency ablation for Morton’s neuroma

Morton’s neuroma causes burning, sharp or tingling pain in the ball of the foot, often spreading into two neighbouring toes, and many people describe a feeling like standing on a pebble. An ultrasound scan confirms the neuroma and shows its size and position.

If wider shoes, insoles and an injection have not helped enough, RFA can be an option before surgery is considered. Studies of RFA for Morton’s neuroma are mostly small, but they report that many patients have a worthwhile reduction in pain and return to normal activities quickly. Some people need a second treatment, and symptoms can come back over time. Surgery remains an option if RFA does not help enough.

Read more about the condition, its symptoms and the other treatment options on our Morton’s neuroma page.

What to expect

1. Assessment: Dr Sankaye reviews your symptoms and any previous scans and treatment, examines you and confirms the painful nerve with ultrasound.
2. Preparation: the skin is cleaned and numbed with local anaesthetic. In some cases a test injection of local anaesthetic is used first, to check that this nerve is the source of your pain.
3. Treatment: the probe is guided to the nerve under ultrasound and the radiofrequency treatment is given. It is done as an outpatient procedure, and you go home the same day.
4. Afterwards: the area may be sore or bruised for a few days. Most people can walk out of the clinic and return to their usual daily activities within a few days. You will be given written aftercare advice.
5. Recovery: pain relief can take a few weeks to build up. A written report is sent to you and, if you wish, your GP, physiotherapist or surgeon.

Risks and side effects

Radiofrequency ablation is minimally invasive and serious complications are uncommon. Possible effects include:

• temporary soreness, bruising or a short-lived flare of pain;
• numbness in the area the nerve supplies, for example between two toes after treatment for Morton’s neuroma;
• infection or bleeding, which are rare;
• pain that does not improve enough, or that comes back over time.

RFA may not be suitable if you have an infection near the treatment area, are pregnant, or have a pacemaker or another implanted electrical device. Please tell us before your appointment if you take blood-thinning medicines.

Why choose LSRI

• Consultant-led care from Dr Prashant Sankaye, Consultant MSK Radiologist with more than 20 years’ experience.
• Diagnosis and ultrasound-guided treatment from the same specialist.
• Two clinics: LSRI Harley Street (W1G 9QJ) and LSRI Northwest London in Harrow (HA2 7SJ).
• No GP referral needed, and all major insurers accepted.

Frequently asked questions

Is radiofrequency ablation painful?

The skin and tissues are numbed with local anaesthetic first, so most people feel pressure rather than pain during the procedure. The area can be sore for a few days afterwards.

How long does the pain relief last?

It varies from person to person. Treated nerves can slowly recover over months, so relief is long-lasting for some people and shorter for others. If RFA helped the first time, it can be repeated.

Is RFA better than surgery for Morton’s neuroma?

RFA is less invasive than surgery and recovery is quicker, but surgery may give a more permanent result for some people. Dr Sankaye will talk through the options with you, including when a foot and ankle surgeon’s opinion is worthwhile.

Will my toes feel numb afterwards?

Some numbness between the two affected toes is common after treatment of a Morton’s neuroma, because the treated nerve carries feeling from that area. Numbness is also expected after surgery for Morton’s neuroma.

Do I need a scan first?

Yes. The nerve is assessed with ultrasound before treatment, and an MRI scan can be arranged if the cause of your pain is not clear.

Book an appointment

Call 0203 633 5040 or book online. Clinics at LSRI Harley Street (The Harley Street Hospital, 19 Harley Street, London W1G 9QJ) and LSRI Northwest London (Medic Care Direct, 62 Station Road, Harrow HA2 7SJ).