Alcohol Sclerosing Injections as an Alternative to Surgery in the Treatment of Neuromas

A neuroma is a benign inflammation of the nerve in the foot, most commonly between the third and fourth toes. Neuromas are caused by the metatarsals and/or tissue rubbing against and irritating the nerves between the metatarsals and the foot. Previous foot problems such as bunions, flatfeet, or hammertoes or high heel shoes can lead to neuromas. Added stress applied to the feet from certain sports such as cycling, running, or skiing and rock climbing can also lead to neuroma formation.

Symptoms of neuromas may include a feeling of your sock has a bulge that you cannot seem to alleviate. Tingling, burning or numbness in the ball of your foot or around the impacted toes are usually present.  The pain usually worsens when wearing tight shoes or with strenuous activities.

Nonsurgical treatments for neuromas may include icing, padding, activity modifications, wider shoes and custom designed orthotics made specifically to offload the affected metatarsals and toes. Cortisone and local anesthetics can also be effective in the treatment of neuromas.

One other successful nonsurgical option in the treatment of neuromas being performed at Ortho Rhode Island is alcohol injections. Alcohol sclerosing injections are a conservative therapy in the treatment of painful neuromas. Alcohol sclerosing injections are a form of chemical neurolysis that is made of a sterile solution of 4% ethyl alcohol mixed with a long-acting Novocain containing epinephrine. This procedure is performed in the office setting and consists of an injection of the mixture just proximal to and around the neuroma. The alcohol injection penetrates into the nerve and causes degeneration and atrophy of the neuroma. The effect is to eliminate the function of the nerve. This injection is given every 10 to 14 days until symptoms subside. Most cases require about 3 to 7 injections and has shown an approximately 90% success rate. Advantages of alcohol sclerosing injections include quick recovery, no downtime and in most cases the ability to avoid surgery.  However surgery in the form of excision or removing of the neuroma might be warranted in the event your symptoms fail with extensive conservative treatment options.