Cryosurgery Or Sclerosing Injections: Which Is Better For Neuromas?
Taking A Closer Look At The Effectiveness Of Sclerosing Injections
Injections of absolute ethyl alcohol (dehydrated sterile alcohol) affect nerves through damage at the cellular level. The cellular effect involves dehydration, necrosis and precipitation of protoplasm. Dehydrated alcohol is soluble in local anesthetic. When it is introduced near nerve tissue, it causes neuritis and chemical neurolysis via Wallerian nerve degeneration.11 While the injected solution has a high affinity for nerve tissue and the desired effect on these tissues, the low concentration reportedly does not have any systemic effect as 90 to 98 percent of ethyl alcohol is oxidized by the body.12
In a 1999 study, the author showed 89 percent improvement with complete relief in 82 of 100 patients who were treated with the sclerosing injections. According to the study, follow-up ranged from six months to two years.5 Patients received a minimum of three injections and no more than seven injections. In regard to the 11 patients who failed injection therapy, the author didn’t identify any soft tissue complications and subsequently proceeded to surgical removal of the neuroma. The author did identify atrophy of the nerve tissue in the patients who failed conservative therapy and a series of sclerosing injections.5
I used these same techniques to treat intermetatarsal and recurrent neuromas, and presented my results in April 2001.7 I treated 29 neuromas (18 primary and 11 recurrent) with sclerosing injections that were given, on average, seven days apart. Marking the site of maximum tenderness prior to injection, I performed all the injections proximal to the entrapped or damaged nerve. Patients received a minimum of three injections and not more than seven injections. I discontinued the therapy if there were complete resolution of symptoms or no relief after three injections.
We scheduled follow-up visits one month after the final injection and six months after the final injection in order to determine the success of therapy. (Some patients returned for other podiatric-related complaints up to three years after sclerosing therapy.) We defined success on patients’ subjective assessment that they had obtained greater than 90 percent relief.
In the primary treatment group, 78 percent of neuromas (14 of 18) were treated successfully with sclerosing therapy. In the recurrent neuroma group, 82 percent of neuromas (nine of 11) were treated successfully.7
There was one side effect, which was local irritation of the plantar foot distal to the injection site but it resolved after one day. Patients who did not have successful therapy had the option of surgical intervention and we saw no injection-related complications intraoperatively or postoperatively.