Abstract
The cause of intermetatarsal neuromas is unclear even if there is a mechanically induced degenerative neuropathy of the intermetatarsal nerve. Treatment of Morton’s neuroma includes conservative methods such as steroid or local anaesthetic injection, orthotic devices and surgical therapy. Surgical therapy has a reported failure rate of between 7% and 24%, depending on the case histories. Dockery in 1999 and Masala et al. in 2001 presented their results on alcoholisation of Morton’s neuroma. The aim of this study is to prove the reproducibility of the aforementioned procedure and its results.
Between December 2001 and March 2004, 30 patients with Morton’s neuroma were examined with US and treated with alcohol injections under US guidance by the same operator. Among these 23 were women and seven men with age ranging between 37 and 70 years. Fifteen patients presented with more than one neuroma in the same foot or in both feet. The standard US was followed by a 3D US in order to extend the diagnosis in treated patients. Alcohol-sclerosing intralesional treatment was performed in 45 neuromas. The treatment consists of an injection cycle (minimum 1, maximum 4), composed of 50% ethyl alcohol (95%) and 50% of a 2% aqueous solution of carbocaine. A total of 90 injections were performed, with an average of two for each neuroma. The patients were examined after the treatment by both authors. On 31 (69%) neuromas, the alcohol-sclerosing intralesional treatment was successful; 14 (31%) neuromas had only a partial improvement and therefore the patients underwent a surgical excision. No procedure-related complications were observed.
The results of this study indicate that, even considering the failure rate, compared to surgery the alcoholisation treatment of neuroma under US guidance is a valuable conservative procedure because of its low morbidity and cost-effectiveness. Alcoholisation under US guidance thus could be a useful tool for orthopaedic surgeons in order to determine whether surgical excision is really necessary.
