Making The Case For Chemical Neurolysis

Author(s): 
By Jeff A. Hall

Foot neuromas are relatively common as they affect all adult age groups. According to the literature on this subject, there are a variety of potential causes (including sensory nerve irritation, injury, tight shoes and biomechanical dysfunction) that may contribute to the common nature of this condition. Some say chemical neurolysis provides a viable treatment alternative, citing the technique’s high success rates and fewer complications. Yet this modality (which has been around for over 50 years) still remains the least commonly applied solution for treating neuromas.Why? Obviously, it’s conventional wisdom to initially employ conservative measures (such as orthotics, tape strapping, cortisone injections, etc.). However, one DPM notes that cortisone injections only provide temporary relief and as Gary Dockery, DPM, suggests in his cover story this month (see page 22), these methods are not immune to complications and may even make the neuroma worse. When conservative care fails, podiatrists proceed to run down the surgical options for the patient. However, as with any surgery, there is an increased risk of complications, including painful scars, postoperative infection and excessive swelling. When attempting to excise a neuroma, those in the know say it can lead to the creation of a stump neuroma in a small percentage of cases. Be aware that stump neuromas are much more painful than the original neuroma. Given the drawbacks of the standard approaches, Dr. Dockery emphasizes using chemical neurolysis (using a dilute solution of ethyl alcohol) as a middle ground treatment of sorts, a modality you consider after conservative care has failed and before you weigh surgical options. Speaking strictly from a layman’s perspective, there do seem to be a number of benefits to this treatment. 1. Treatment results. In a previous study of using chemical neurolysis to treat intermetatarsal neuromas, Dr. Dockery reported an 89 percent success rate. One practitioner I spoke with noted that he has treated 19 foot neuroma cases with chemical neurolysis since May and 14 of those patients achieved 100 percent resolution of their symptoms. That’s a 73 percent success rate. Others report a greater than 60 percent success ratio. Granted, the success rate tends to vary depending upon whom you talk to and what literature you’re reading. However, if the success rates tend to be on the high end with reportedly minimal complications, it makes sense to consider chemical neurolysis before proceeding with a potentially riskier surgery. 2. Better reimbursement than surgery. In a direct comparison of chemical neurolysis and the complete surgical excision of the neuroma, there seems to be a general consensus that effective chemical neurolysis is far more cost-effective and actually pays better when it comes to economies of scale. One DPM notes that he receives $150 to $200 in reimbursement per treatment when performing chemical neurolysis via injection whereas he only receives $300 for surgery with a 90-day post-surgery follow-up. 3. Reduced inconvenience for the patient. However, it’s important to point out there is a quicker recovery time for this procedure as opposed to complete excision of the neuroma, which may necessitate two to four weeks away from jobs that require prolonged standing or walking. If given a choice, I’m sure patients will prefer walking away with a Band-Aid for minor bleeding from the injection. At the very least, chemical neurolysis warrants further attention and consideration. Perhaps more studies are needed before it becomes a more mainstream option for treating foot neuromas. However, given the benefits noted above, I think it’s just a matter of time.

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