Chemical Neurolysis for Treatment of Neuroma

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Our goal when treating neuromas is to relieve your pain in the most conservative way possible. If orthotics and corticosteroid injections do not completely relieve your pain we may recommend “chemical neurolysis”.

Using a chemical to cause destruction of the enlarged nerve, called neurolysis or sclerosing injection, is an older treatment that has recently been shown in several studies to be an effective method to treat neuromas with much less risk than surgery.

This treatment requires a series of injections, given about 10 days apart, of an alcohol solution (ethanol) mixed with a local anesthetic. The nerve tissue absorbs the ethanol which acts over repeated exposure to destroy the portion of the nerve that is causing your pain. Before injecting the alcohol solution we first numb your foot to ensure that you have no pain during the procedure. To ensure precise placement of the injection directly into the neuroma we utilize diagnostic ultrasound which allows us to see exactly where the injection is being placed.

Success Rate
Studies report success rates (complete pain relief) of between 61% and 89%. All studies report very few side effects.

Advantages

• Good success rate with few complications
• No down time for the patient
• Minimal pain at time of injection (we are very good at providing less painful injections)
• Helps prevent the need for surgery
• Much less expensive than surgery

Disadvantages

• Requires multiple trips to our office (usually 5 – 7 for best long term results)
• Occasional pain on the day or two following injection.

Other Treatments
If orthotics, shoe changes, steroid injection and chemical neurolysis all fail to adequately relieve your pain then surgical removal of the neuroma is the only other available treatment.

Medical References
1. Efficacy of chemical neurolysis for the treatment of interdigital nerve compression of the foot: a retrospective study. Mozena JD, Clifford JT. J Am Podiatr Med Assoc. 2007 May-Jun;97(3):203-6.

2. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Hughes RJ, AJR Am J Roentgenol. 2007 Jun;188(6):1535-9.

3. The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. Dockery, GL. Foot Ankle Surg. 1999 Nov-Dec;38(6):403-8.

 

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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