A Closer Look At Alcohol Injection Techniques For Morton`s Neuroma

A patient recently contacted me after having alcohol injections for Morton's neuroma. She had unsuccessful surgery several years ago for Morton's neuroma and was having the same pain level after surgery as before surgery. Her insurance company denied my request for another magnetic resonance image (MRI) since I was not going to do more surgery. I just wanted to know what I was dealing with.  

When I first started using these injections, using 4% alcohol to desensitize the nerves was common. Half the time, the relief was good enough that patients could avoid surgery but the other half of those patients required surgery. So I started upping the dose of the alchol injections. Now, I start patients at 10% and titrate them up to 20% (my max). I definitely have more flare-ups that last four days to two weeks but my percentage of patients needing surgery seems lower. I just want to get the most out of these shots. To anyone who thinks injecting nerves with alcohol is simple, it is not. It takes great effort and much patient counsel. You are trying to avoid surgery and its corresponding issues.     

There are so many other treatments for Morton's neuroma to try first as only 2 percent of my Morton's neuroma patients even need to consider these shots. Since I am trying to perfect how I use the alcohol injections, I am trying to prevent complications in the 1 percent of my Morton’s neuroma patients who still need surgery. In my clinical experience, 99 percent of these patients never need alcohol injections in their treatment.

My patient wanted to know if I had some knowledge of possible side effects from 20% alcohol injections so I sent her a study by Hughes and colleagues, noting that this concentration of alcohol injection led to no major complications.¹ I have also written several blogs on alcohol injections.^2–4

The only issue I have with alcohol injections in my practice is that I do not use ultrasound. I have been giving these shots forever into the nerve and know where to inject. Yet, I do know there many variations of nerve alignments so how close do you have to be with the injection? I feel secure that our surgeons at my facility and MRI imaging have never found damage post-shots to my knowledge.

References

1. Hughes RJ, Ali K, Jones H, et al. Treatment of Morton’s neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. Am J Roentgenol. 2007; 188(6):1535–9.

2. Blake R. Morton’s neuroma: which shots to get? Available at https://www.drblakeshealingsole.com/2010/08/mortons-neuromas-which-shots-to-get.html . Published June 26, 2016.

3. Blake R. Evaluation of possible Morton’s neuromas. Available at https://www.drblakeshealingsole.com/2011/05/evaluation-of-possible-mortons-neuromas.html . Published May 28, 2011.

4. Blake R. Morton’s neuroma: general principles. Available at https://www.drblakeshealingsole.com/2015/01/mortons-neuroma-general-principles.html . Published Jan. 2, 2015.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/04/alcohol-injections-for-mortons-neuroma.html. It is reprinted with permission from the author.