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Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up


Morton’s neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine–adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20–30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success.

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  1. 1.

    Wu KK (1996) Morton’s interdigital neuroma: a clinical review of its etiology, treatment, and results. J Foot Ankle Surg 35:112–119

    CAS  PubMed  Google Scholar 

  2. 2.

    Meachim G, Abberton JJ (1971) Histological findings in Morton’s metatarsalgia. J Pathol 103:209–217

    Google Scholar 

  3. 3.

    Durlacher L (1845) In: Treatise on corns, bunions, diseases of nails, and the general management of the feet. Simpkin and Marshall, London, p 52

  4. 4.

    Morton TG (1876) A peculiar and painful affection of the fourth metatarsophalangeal articulation. Am J Med Sci 71:37–45

    Google Scholar 

  5. 5.

    Young G, Lindsey J (1993) Etiology of symptomatic recurrent interdigital neuromas. J Am Podiatr Med Assoc 83:255–258

    CAS  PubMed  Google Scholar 

  6. 6.

    Vachon P, Lemay M, Bouchard HL (1991) Pathologic study of Morton’s neuroma. Can J Surg 34:356–358

    CAS  PubMed  Google Scholar 

  7. 7.

    Ha’Eri GB, Fornasier VL, Schatzker J (1979) Morton’s neuroma: pathogenesis and ultrastructure. Clin Orthop 141:256–259

    PubMed  Google Scholar 

  8. 8.

    Tate RO, Rusin JJ (1978) Morton’s neuroma: its ultrastructural anatomy and biomechanical etiology. J Am Podiatry Assoc 68:797–807

    CAS  PubMed  Google Scholar 

  9. 9.

    Quinn TJ, Jacobson JA, Craig JG, van Holsbeeck MT (2000) Sonography of Morton’s neuromas. Am J Roentgenol 174:1723–1728

    CAS  Google Scholar 

  10. 10.

    Morscher E, Ulrich J, Dick W (2000) Morton’s intermetatarsal neuroma: morphology and histological substrate. Foot Ankle Int 21:558–562

    CAS  PubMed  Google Scholar 

  11. 11.

    Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT (1999) From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic–pathologic correlation. Radiographics 19:1253–1280

    CAS  PubMed  Google Scholar 

  12. 12.

    Graham CE, Graham DM (1984) Morton’s neuroma: a microscopic evaluation. Foot Ankle 5:150–153

    CAS  PubMed  Google Scholar 

  13. 13.

    Bourke G, Owen J, Machet D (1994) Histological comparison of the third interdigital nerve in patients with Morton’s metatarsalgia and control patients. Aust N Z J Surg 64:421–424

    CAS  PubMed  Google Scholar 

  14. 14.

    Bencardino J, Rosenberg ZS, Beltran J, Liu X, Marty-Delfaut E (2000) Morton’s neuroma: Is it always symptomatic? Am J Roentgenol 175:649–653

    CAS  Google Scholar 

  15. 15.

    Mendicino SS, Rockett MS (1979) Morton’s neuroma: update on diagnosis and imaging. Clin Podiatr Med Surg 14:303–311

    Google Scholar 

  16. 16.

    Okafor B, Shergill G, Angel J (1997) Treatment of Morton’s neuroma by neurolysis. Foot Ankle Int 18:284–287

    CAS  PubMed  Google Scholar 

  17. 17.

    Shapiro PP, Shapiro SL (1995) Sonographic evaluation of interdigital neuromas. Foot Ankle Int 16:604–606

    CAS  PubMed  Google Scholar 

  18. 18.

    Milgram JE (1993) Design and use of pads and strappings for office relief of the painful foot. In: Kiene RH, Johnson KA (eds) Symposium of the foot and ankle. Mosby, St. Louis, pp 95–101

  19. 19.

    Goslin R, Tollafield DR, Rome K (1997) Mechanical therapeutics in the clinic. In: Tollafield DR, Merriman LM (eds) Clinical skills in treating the foot, vol 11. Churchill Livingstone, London, pp187–216

  20. 20.

    Tollafield DR, Pratt DJ, Rome K (1997) Prescription orthoses. In: Tollafield DR, Merriman LM (eds) Clinical skills in treating the foot, vol 11. Churchill Livingstone, London, pp 217–247

  21. 21.

    Dockery GL (1999) The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections. J Foot Ankle Surg 6:403–408

    Google Scholar 

  22. 22.

    Masala S, Fanucci E, Ronconi P, Taormina P, Romagnoli A, Simonetti G (2001) Treatment of intermetatarsal neuromas with alcohol injection under US guide. Radiol Med 102:370–373

    CAS  Google Scholar 

  23. 23.

    Frisca DA, Strom DE, Parr JW, Saltzman CL, Johnson KA (1991) Surgical treatment for primary interdigital neuroma. Orthopedics 14:669–672

    PubMed  Google Scholar 

  24. 24.

    Keh RA, Ballew KK, Higgins KR, Odom R, Harkless LB (1992) Long-term follow-up of Morton’s neuroma. J Foot Surg 31:93–95

    CAS  PubMed  Google Scholar 

  25. 25.

    Wilson S, Kuwada GT (1995) Retrospective study of the use of a plantar transverse incision vs a dorsal incision for excision of neuroma. J Foot Ankle Surg 34:537–546

    CAS  PubMed  Google Scholar 

  26. 26.

    Gudas C, Mattana G (1986) Retrospective analysis of intermetatarsal neuroma excision with preservation of the transverse metatarsal ligament. J Foot Surg 25:459–463

    CAS  PubMed  Google Scholar 

  27. 27.

    Diebold PF, Daum B, Dang-Vu V, Litchinko M (1996) True epineural neurolysis in Morton’s neuroma: a 5-year follow up. Orthopedics 19:397–400

    CAS  PubMed  Google Scholar 

  28. 28.

    Price PD, Miller G (1992) Internal neurolysis. J Foot Surg 31:250–259

    CAS  PubMed  Google Scholar 

  29. 29.

    Mulder JD (1951) The causative mechanism in Morton’s metatarsalgia. J Bone Joint Surg 33B:94–95

    Google Scholar 

  30. 30.

    Johnson JE, Johnson KA, Unni KK (1988) Persistent excision on an interdigital neuroma. J Bone Joint Surg 10A:651–657

    Google Scholar 

  31. 31.

    Barrett SL, Pignetti TT (1994) Endoscopic decompression for intermetatarsal nerve entrapment: the EDIN technique: preliminary study with cadaveric specimens; early clinical results. J Foot Ankle Surg 33:503–508

    CAS  PubMed  Google Scholar 

  32. 32.

    Hodor L, Barkal K, Hatch-Fox LD (1997) Cryogenic denervation of the intermetatarsal space neuroma. J Foot Ankle Surg 36:311–314

    CAS  PubMed  Google Scholar 

  33. 33.

    Rengachary SS, Watanabe IS, Singer P, Bopp WJ (1983) Effect of glycerolon peripheral nerve: an experimental study. Neurosurgery 13:681–688

    CAS  PubMed  Google Scholar 

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Correspondence to Ezio Fanucci.

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Fanucci, E., Masala, S., Fabiano, S. et al. Treatment of intermetatarsal Morton’s neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol 14, 514–518 (2004).

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  • Foot
  • Alcohol
  • Morton’s neuroma
  • US
  • Peripheral neuropathies