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Effects of 4% Ethanol Sclerosing Injection on Morton's Neuroma: A Histologic Study

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Background

Nonoperational treatments for Morton's neuroma remain controversial because it is believed that sclerosing injections do not change nerve fibers on a cellular level. Up to 80% success rates with 4% ethanol sclerosing have been documented, and the remainder required operational removal of the painful nerve. We sought to evaluate the histologic characteristics of Morton's neuromas treated with 4% ethanol sclerosing injection versus corticosteroid injection alone in patients who required removal of the nerve for pain relief.

Methods

A retrospective histologic review was performed of 23 consecutive patients who were treated with either sclerosing injection or nonsclerosing injection and underwent nerve removal between September 1, 2012, and February 28, 2015.

Results

Of 19 patients who met the inclusion criteria, eight received sclerosing injections and 11 received nonsclerosing injections. Intraneural fibrosis was more severe in the nonsclerosing injection group (P = .008).

Conclusion

Histologic changes are seen in Morton's neuroma with the use of 4% ethanol sclerosing injection, contrary to findings from previous studies.

Department of Podiatry, Johnson Memorial Hospital, IU Health North Hospital, Franklin, IN.

AmeriPath Indiana, Indianapolis, IN.

Hoosier Foot & Ankle, Franklin, IN.

Department of Podiatric Surgery, St. Vincent's Hospital, Indianapolis, IN.

The Foot Doctors of Santa Cruz County, Santa Cruz, CA. Dr. Nguyen is now with Pacific Point Podiatry, Freedom, CA.

Corresponding author: Patrick A. DeHeer, DPM, Department of Podiatry, Johnson Memorial Hospital, IU Health North Hospital, 1159 W Jefferson St, Suite 204, Franklin, IN 46131. (E-mail: padeheer@apma.org)