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Your experiences with alcohol sclerosing injections ??

Posted by Nan D on 5/21/03 at 14:19 (119524)

My pain from Morton's Neuroma is almost totally gone, but the neuroma is still there and a little bothersome when wearing other shoes except sneakers or SAS sandals. I found a highly recommended Pod. who suggests alcohol sclerosing injections. He says the success rate is 85% to reduce the neuroma with 3-8 injections. Does anyone have any pros or cons of this procedure? If so, do the injections hurt(it sounds *terrible*!) and did it prevent you from walking the next day? THANKS!

Re: Your experiences with alcohol sclerosing injections ??

Ed Davis, DPM on 5/21/03 at 21:30 (119583)

Nan:

Much depends on the size of the neuroma. A large neuroma is less likely to improve via the sclerosing injections that a smaller one. One thing to consider is that the shots don't really feel that great so getting shot up to eight times may discourage some. The other thing to consider is that neuroma surgery is not a major procedure, is generally successful and is definitive. As such, I would not necessarily advise going through a protracted, potentially painful series of shots which leave the neuroma intact when removing the neuroma is relatively simple, quick and curative.
Ed

Re: Your experiences with alcohol sclerosing injections ??

elliott on 5/22/03 at 10:39 (119641)

Dr. Ed, regarding a lot of shots, if the only issue is temporary pain, given the alternative I say temporary pain is no pain, and shouldn't be an issue, given that these nerve things having a way of becoming lifetime debilitating problems. I think you've posted that you feel neuroma surgery has success rates of something like 99%, but my suspicion is that it's more like 85%, certainly good enough to consider, but that means about one in every 6 or 7 is screwed. ('You feeling lucky--punk?' Clint Eastwood.) Those are then relegated to that murky area of revision neuroma surgery, involving resection, stumps, and all that other scary language used in articles by big-name docs dealing with such problems. I'll take the shots. (BTW, if nerve blocks are supposed to be just as painful as sclerosing alcohol, I think I'm practically immune to the pain by now, barely feeling the needle prick and not even frightened by it. I actually look forward to them and the temporary numbness they provide, as I dream that when the numbness wears off, I'll be all better. After shot #4, I think I'm up to around 70% improvement on whatever it is I have and, assuming no regression, am now past considering surgery for this problem.

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Re: Your experiences with alcohol sclerosing injections ??

Ed Davis, DPM on 5/23/03 at 18:31 (119770)

Elliott:

I would say about 90% as opposed to 99%. One problem with shots is that the relief may be temporary. Patients in whom the shots don't work have used up 6 to 8 weeks of time -- most patients wiht neuroma surgery feel better 2 weeks out than before the surgery. I always give patients the option though. As you know, I am not impressed with a lot of 'big name' docs --- perhaps they are not that 'big' if they have to do revisonal surgery on more than a very small percentage of neuroma surgery.
Ed

Re: Your experiences with alcohol sclerosing injections ??

Nan D on 5/23/03 at 21:15 (119782)

Hello Elliot,

Thanks for your quite logical opinion, as I am also very leary about surgery with all the horror stories described after surgery. So far, I've gotten about an 80% improvement of pain by wearing my EZ Runner Orthotics for almost 5 months.(i.e. SDO's ... see Dr Kiper under Products pg)

I have only a slight discomfort from the neuroma periodically, but still question the alcohol treatments which seem extreme & potentially damaging, since I don't have that much pain. I would like for this to be totally gone though, to be able to get back to running & wearing stylish shoes again!(I only have one foot with the problem, thank goodness.) How much pain do you have and do the shots hamper you from walking at all after having them? My GP talked me into a cortisone shot about a month ago, which made it much worse, & I couldn't walk well for several days.(UGH!)

Have you or anyone else tried anti-inflammatory creams, foot baths, acupuncture, or ice packs on neuromas?

.....THIS is SO frustrating........
THEY can transplant hearts, but CAN'T effectively repair feet...
......something is terribly wrong here.....??!!

Thanks for your help!
Nan ;-)

Re: Your experiences with alcohol sclerosing injections ??

elliott on 5/25/03 at 00:11 (119862)

Dr. Ed, I'm almost sure you said upper 90s not too long ago, but whatever. To me, 6 to 8 weeks of 'used up' time is absolutely nothing compared to the possibilty of facing lifelong chronic nerve pain if the surgery is not successful.

The 'big-name' docs are not doing revision neuroma surgery on their own patients too often; rather, they are attracting patients from around the country whose first surgery failed despite the 95% success rate and who really need it to go right this time, even though now their odds are lower.

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Re: Your experiences with alcohol sclerosing injections ??

elliott on 5/25/03 at 00:21 (119863)

Nan, the alcohol injections have merit depending on circumstances, but they can leave one with permanent loss of feeling that can be hard to handle as well. Pure nerve blocks (lidocaine/marcaine) are more or less 'free', i.e. no real risks to speak of, but usually offer only temporary relief. I hope I'm lucky in that regard. They do offer great diagnostic value in pinpointing exactly where the problem is, be it for a future cortisone shot or for surgery.

I have never had any reaction (other than the temporary numbness I'm supposed to have) or trouble walking from any of my nerve block or cortisone shots, and I believe at least some of that has to do with the doc injecting the needle. I'd say the GP is not the right doc to do this. You should try a specialist who has lots of experience handling neuromas. There is a skill level required in targeting the nerve branches properly.

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Re: Your experiences with alcohol sclerosing injections ??

Nan D on 5/26/03 at 10:50 (119953)

Elliott, Thanks for the interesting info! HOW do you find a 'real specialist' for neuromas. I've been to 3 Pods, ALL claiming to be SPECIALISTS and all BIG LOSERS!!!! What type of doc do you have?

Re: Your experiences with alcohol sclerosing injections ??

Dr. Z on 5/26/03 at 11:07 (119954)

You can go the the web site for the American College of Foot and Ankle Surgeons and do a search for a Board Certified Foot and Ankle Surgeon. May
have to just call around and ask if the podiatrist does the alcohol sclerosing injections. I have used this procedure for years and still find it very rewarding. Some patients may be to have foot surgery. There is a new article in the APMA journal which talks about a different surgical procedure whereby the surgeon moves the neuroma above the intermetatarsal ligament instead of cutting the nerve out . The results were very promising
There was no permament numbing effect with this procedure if that is a concern to you. The healing time was very fast

Re: Your experiences with alcohol sclerosing injections ??

Nan D on 5/27/03 at 23:39 (120096)

Thanks for the info Dr Z!

The Pod I went to had FACFAS(what's that?) on his card plus Diplomate, American Board of Pod. Surgery. Is the Board Cert. Foot & Ankle Surgery different?

I am very active athletically, and do not ever want my foot permanently
numbed. I would rather just 'live' with the small amount of pain left. But,
hate wearing those 'old lady' shoes!;-) I think the youngest person in SAS Shoes, last time I was there, was 80!

Re: Your experiences with alcohol sclerosing injections ??

Ed Davis, DPM on 5/28/03 at 21:17 (120224)

Elliott:

The possibility of 'facing lifelong chronic nerve pain' if surgery is unsuccessful is remote. There is usually an identifiable reason that can be corrected if surgery fails. This happens to be a situation that the reward to risk ratio is clearly in favor of the surgery.
Ed

Re: Your experiences with alcohol sclerosing injections ??

Dr. Z on 5/28/03 at 22:10 (120233)

Ed

Did you read this month's issue of JAPMA.? Very interesting article on neuroma surgery. Instead of excisiong he nerve it is moved above the inter-metatarsal ligament. Could be a better operation then excision. Ever done this procedure.

Re: Your experiences with alcohol sclerosing injections ??

Ed Davis, DPM on 5/29/03 at 14:44 (120298)

Dr. Z:

I haven't but understand that that concept has been pushed by a number of EPF advocates. They use the endoscope to release the transverse metatarsal ligament.

Here is a situation where we have a procedure, in simple neuroma excision, that is so simple and relatively successful that alternative approaches carry a burden of proof to show why they could be better.

Ed