Abstract
Background
Morton's neuroma (MN) is a common cause of metatarsalgia. Whilst there are a many treatment modalities available, studies looking at the long term effectiveness of most forms of treatment are scarce. The injection of MN with alcohol has gained popularity over the past ten years with widespread media coverage. Many surgeons have anecdotally questioned the long-term effectiveness. Sixty patients underwent alcohol injection for the treatment of MN by Radiologists at our institution. These results were originally published showing 92% (92/100) success rates and only 3% (3/100) requiring surgical excision at a mean follow up of 10.5 mths. The authors concluded that alcohol injection was comparable to results for surgical excision.
Methods
We were able to review forty five of this original cohort with an average follow up of 61 (range, 33 to 73) months. The modified Johnson score and visual analogue scales were used to assess the patients and compare these results to five year results available in the literature for surgical management.
Results
Our results indicated that by five years 36% (16/45) had undergone surgical treatment and a further 45% (13/29) had return of symptoms. Only 29% (13/45) remained symptom free. Results at five years showed statistically significant differences (P< 0.05) compared to surgical management, with 67.8% complete resolution of symptoms with surgery and 33% in the alcohol injection group.
Conclusion
Injection with alcohol sclerosant for MN has been marketed as a definitive management option comparable to surgical excision. Our investigation illustrated that although short term results are encouraging; alcohol injection does not offer permanent resolution of symptoms for most patients, can be associated with considerable morbidity and that results are not comparable to surgery. Our investigation provides the only long term data for alcohol injection treatment of MN.
