Abstract | BACKGROUND:
Morton's neuroma is a common cause of forefoot pain. Various conservative methods ( injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol. METHODS: Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)-verified neuroma. We evaluated patients at up to 5-year follow-up. RESULTS: A "success rate" of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form-36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement (P < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports. CONCLUSION: The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton's neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain. LEVEL OF EVIDENCE: Level IV, cases series, prospective.
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Authors | Christof Pabinger, Isabella Malaj, Harald Lothaller, Elena Samaila, Bruno Magnan |
Journal | Foot & ankle international
(Foot Ankle Int)
Vol. 41
Issue 5
Pg. 590-595
(05 2020)
ISSN: 1944-7876 [Electronic] United States |
PMID | 32013586
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Aged
- Ethanol
(administration & dosage)
- Female
- Fluoroscopy
- Humans
- Injections, Intralesional
(methods)
- Male
- Middle Aged
- Morton Neuroma
(drug therapy)
- Prospective Studies
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