Posts for tag: Neuroma Chattanooga

January 09, 2015
Category: F.Y.I.

Sclerosing Injections are a series of injections often used to treat a painful Morton's Neuroma in the foot.  A Morton's Neuroma is a nerve inflammation or neuritis that occurs when a nerve on the bottom of the foot, usually between the third and fourth toes, becomes compressed or otherwise irritated and enlarges.  It is NOT a tumor, despite the name given to it many years ago by Dr. Morton.  Pain and numbness starting in the ball of the foot and radiating into the toes is a common symptom, and it often becomes worse as the nerve becomes more inflamed or enlarged.  There are several ways to treat neuromas, with surgery being done less and less often.

 Steroid (cortisone) injecions and orthotic devices are probably used in the majority of cases first, especially if padding and changes in shoes do not help.  Unlike steroid injections which are given to shrink the nerve, often temporarily, sclerosing injections are given to cause a chemical neurolysis of the nerve, basically making the nerve no longer work.  While nothing is successful 100% if the time, a series of sclerosing injections, often between 3 and 7 of them spaced 10 to 14 days apart, is often very helpful in reducing and often eliminating the pain, numbness, burning, and tingling of a neuroma.

  Typically, a very small amount of the medication, often less than 1.0cc, is infiltrated directly into or on the nerve.  It is helpful to use ULTRASONIC GUIDANCE for this treatment to be sure the medication is right at or in the nerve.  With steroid injections, a larger amount of fluid is injected near the nerve, so that the medication "bathes" the nerve.  It is more important with a sclerosing injection to give the medication right at or behind the bifurcation (the y-shaped area where the nerve splits into two branches). 

A very small needle can be used for this, usually smaller than that used for a steroid injection, as long acting steroid medications are "thicker" and are not easily administered through a very thin needle.  The procedure takes only a few minutes, and the patient is helpful in communicating with the doctor when she feels the doctor is "getting close to the nerve."  Sharp, electrical shock type pains, which are relatively brief, will tell the patient the needle is very close to the nerve.  The medication is given in that spot, and then the procedure is over.

  The sclerosing mixture used is often a mixture of absolute alcohol, Marcaine (a long acting anesthetic), and epinephrine.  In the U.S., it is common to use a 4% solution, but in europe, where the procedure has been done for a much longer period of time, high concentrations of the medication are used.  This increases the effectiveness, and may reduce the number of injections needed, but it does carry some risk of "burning" the skin.  I, personally, have found that a 10% mixture works well in a majority of cases, and have had no untoward effects with that strength.  I have heard of mixtures as high as 20% being used in Europe, with a high success rate, but also a sometimes unacceptable rate of side effects.  In any case, the sclerosing injections are usually given every 10-14 days until the patient sees a nearly complete resolution of symptoms.  I have found, in my practice, that anywhere from 3 to 7 are needed.  We usually then evaluate the patient several weeks to a few months later, to be sure there is no recurrence.

Dr. Richard S. Eby

(423) 622-2663