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In patients with plantar interdigital neuroma of the foot, also called ‘Morton's neuroma’, ultrasound-guided injections of alcohol into the lesion has a high success rate and is well tolerated, a UK study shows.

In patients with plantar interdigital neuroma of the foot, also called ‘Morton's neuroma’, ultrasound-guided injections of alcohol into the lesion has a high success rate and is well tolerated, a UK study shows.

"The results are at least comparable to surgery, but alcohol injection is associated with less morbidity and surgical management may be reserved for nonresponders," concludes the study team led by Dr. David A. Connell of the Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Middlesex.

In the June issue of the American Journal of Roentgenology, the clinicians report outcomes for 101 consecutive patients with Morton's neuroma who each underwent an average of 4.1 ultrasound-guided alcohol injections and were followed for a mean of 21.1 months after the last treatment.

"Technical success was 100 per cent," according to the team, and 94 per cent reported partial or total symptom improvement, with 84 per cent becoming totally pain-free. "The mean visual assessed pain score decreased from eight before treatment to 0 after treatment (p < 0.001)," Dr. Connell and colleagues note. Seventeen patients (16.8 per cent) experienced a transient increase in local pain.

Sonography performed six months after the last treatment in 30 patients showed a 30 per cent decrease in neuroma size. There were no major complications.

Ultrasound-guided alcohol injection appears to be a safe, effective and less invasive alternative to surgery for patients with Morton's neuroma, the authors conclude.

"Surprisingly," Dr. Connell added in a written statement, "most patients maintain innervation to the toes despite the alcohol ablation. They don't have permanent numbness and loss of sensation that accompanies resection of the nerve at surgery.