In a previous article on this web site, neuromas were discussed. As a potential treatment, the injection of 4% alcohol into an intermetatarsal neuroma was an alternative to surgical excision of the neuroma(s). In the latest issue of The Journal of Foot & Ankle Surgery (volume 38, number 6 Nov/Dec 1999), Gary L. Dockery, DPM, discussed the results of this treatment. These showed promising responses to this method of treatment for neuromas.

Sclerosing agents have been used with great success to reduce and eliminate the spider varicosities (small dialated blood vessels) of the skin. The sclerosing (scarring) agent used in the treatment of neuromas is 4% dehydrated alcohol with 0.5% bupivacaine HCL with epinephrine (1:200,000). A volume of 0.5 ml of this mixture was injected proximal to the neuroma. This treatment was repeated 3 - 7 times and the results were encouraging. The study of 100 patients over a ten year period revealed 82% of the patients found 100% relief; 7% found 60-75% improvement; and 11% found 0% improvement. The most common complaint after initial treatment was an increase in symptoms when the anesthetic bupivacaine "wore off." The symptom felt was a "pins and needles" sensation; and was not noted after the second treatment. The average duration of this complaint heightened at 48 hours post injection and decreased rapidly then after.

The mechanism Dockery attributed to improvement was cited by Rengachery et al (and others) as a chemical neurolysis (break down) of the nerve, therefore decreasing and eliminating the pain transmission of the neuroma. I have personally had limited experience with this treatment, but have found it encouraging. This treatment is an alternative to what commonly ends as a surgical excision of the neuroma. It is, however, costly. But when compared to the surgical fee, out-patient facility fee, and "down time" of the standard excisional surgery , this treatment is actually far less expensive. At present, the results do show a rewarding alternative to the treatment of painful neuromas, but, as with all treatments, complication and failure is a possibility. For more information on neuromas, see Neuroma.

Dr. Graham has been in private practice in Effingham since 1989 and is on staff at St. Anthony's Memorial Hospital and Effingham Ambulatory Surgical Treatment Center. He is Board Certified by the American Board of Podiatric Surgery and American Board of Podiatric Orthopaedics and Primary Podiatric Medicine. Dr. Graham is a Fellow of the American College of Foot and Ankle Surgeons, the American College of Foot and Ankle Orthopaedics and Medicine, and American Professional Wound Care Association. He is also a member of the American Podiatric Medical Association and the Illinois Podiatric Medical Association.

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