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Treatment of Morton's Neuroma with Alcohol Injection Under Sonographic Guidance: Follow-Up of 101 Cases

¹ Department of Radiology, Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
² Department of Rheumatology, Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Middlesex, United Kingdom.
³ Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Middlesex, United Kingdom.

OBJECTIVE. Morton's neuroma is a common cause of forefoot pain. For this study, we assessed the efficacy of a series of sonographically guided alcohol injections into the lesion.

SUBJECTS AND METHODS. One hundred one consecutive patients with Morton's neuroma were included in this prospective series. An average of 4.1 treatments per person were administered, and follow-up images were obtained at a mean of 21.1 months after the last treatment (range, 13–34 months).

RESULTS. Technical success was 100%. Partial or total symptom improvement was reported by 94% of the patients, with 84% becoming totally pain-free. The median visual assessed pain score decreased from 8 before treatment to 0 after treatment (p < 0.001). Transitory increased local pain occurred in 17 cases (16.8%). There were no major complications. Thirty patients underwent sonography at 6 months after the last injection and showed a 30% decrease in the size of the neuroma.

CONCLUSION. We conclude that alcohol injection of Morton's neuroma has a high success rate and is well tolerated. The results are at least comparable to surgery, but alcohol injection is associated with less morbidity and surgical management may be reserved for nonresponders.

Keywords: ablation • alcohol injection • foot • Morton's neuroma • musculoskeletal imaging • sonographic guidance

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