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

Foot (Edinb). 2018 Jun:35:36-47. doi: 10.1016/j.foot.2017.12.003. Epub 2017 Dec 28.

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.

Keywords: Alcohol injections; Intermetatarsal neuroma; Morton’s neuroma; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Animals
  • Disease Models, Animal
  • Ethanol / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intralesional
  • Male
  • Metatarsalgia / etiology
  • Metatarsalgia / therapy
  • Middle Aged
  • Morton Neuroma / complications
  • Morton Neuroma / diagnostic imaging
  • Morton Neuroma / therapy*
  • Pain Measurement*
  • Rats
  • Risk Assessment
  • Sclerosing Solutions / therapeutic use*
  • Sclerotherapy / methods
  • Severity of Illness Index
  • Treatment Outcome
  • Ultrasonography, Doppler

Substances

  • Sclerosing Solutions
  • Ethanol