Sclerosing alcohol injections for the management of intermetatarsal neuromas: A systematic review

Abstract

An intermetatarsal neuroma is a plantar digital neuritis causing metatarsalgia of the affected inter-metatarsal space. At present the evidence to support the management of the condition is poor with only some quality evidence supporting the short-term management of intermetatarsal neuromas using steroid injections. Some authors have supported the use of alcohol sclerosing intra-lesional injections to treat intermetatarsal neuromas. Following a search of the evidence 11 articles were identified. The systematic review found that alcohol injections appear to be safe although some papers report a short-term side effect of a flogistic reaction and there are variances in the alcohol concentration used and guiding verses not guiding the injection using ultrasound imaging. Some of the evidence may suggest a sclerosing histological effect of the nerve. However, all the studies reviewed present a research design offering a low level of evidence that is open to methodological biases and interpretation. Thus, this review found insufficient high-quality research evidence to afford conclusions on the management of intermetatarsal neuromas with alcohol sclerosing agent injections.

Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review

“…In addition to the short-term effects, Perini et al also noted diminished short-term pain after injection in 73% of their patients (P \ 0.001) [11]. However, there were side effects that resulted in pain in the injection site, skin lesions, tissue alterations consist with ''steroid flare,'' tissue atrophy, and pigment alterations [9,11].…”

“…More recently, one randomized study indicated that though both treatments improved outcomes for 18 months, corticosteroids had a greater improvement than PRP within 1 month of injection, and PRP had a more positive effect than ICS at 6-, 12-, and 18-month follow-ups [38]. Conversely, two other studies found that ICS and PRP both improved outcomes up to 16 weeks and 6 months, respectively, with no difference between level of improvement due to the two treatments [8,9].…”

“…Steroid treatment is commonly used to alleviate symptoms along with changes in footwear and stretching [9]. Principal findings by Lizano-Diez et al showed that corticosteroid injections with local anesthetics did improve symptoms temporarily between the experimental and control groups (P = 0.012).…”

“…Alcohol is usually mixed with a local anesthetic and guided via ultrasound into the neuroma [11]. The concentration of alcohol that is injected for MN varies, although the beneficial results are amplified as the concentration of alcohol increases [9]. There is local transient pain at the site of injection as the concentration of alcohol is increased from 30 to 50%, but it is short lived [9].…”

“…The concentration of alcohol that is injected for MN varies, although the beneficial results are amplified as the concentration of alcohol increases [9]. There is local transient pain at the site of injection as the concentration of alcohol is increased from 30 to 50%, but it is short lived [9]. More research needs to be conducted on alcohol-based treatments and this therapy should only be used if more evidence-based treatments fail to produce beneficial results [9,11].…”