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Saturday, April 14, 2018

Alcohol Injections for Morton's Neuroma

     I just got an email from a patient undergoing alcohol shots for Morton's neuroma. She had unsuccessful surgery several years ago for Morton's neuroma, having the same pain after surgery as before. Her insurance company denied my request for another post-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 4% alcohol to de-sensitize the nerves was common. 50% of the time the relief was good enough that the patients could avoid surgery. But, 50% of those patients required surgery. So, I started upping the dose. Now, I start patients at 10% titrate them to 20% (my max). I definitely have more flare-ups that last 4 days to 2 weeks, but my % percentage of patients needing surgery seems less. I just want to get the most out of these shots. 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 it's issues, a noble cause? 
     There are so many other treatments for Morton's neuroma that should be tried first that only 2% of my Morton's neuroma patients need even to consider these shots. Since I am trying to perfect how I use the alcohol, I am trying to prevent the 1% of my Morton Neuroma patients that still need surgery. 99% of these patients never need these shots in their treatment. My patient wanted to know if I had some knowledge of possible side effects from 20% shots so I sent her the link to the article below.

Dr. Blake's response to her email: 
     Thanks for the email. I had to try to find the article on 20% that made me go above 4% years ago. I think it is well written. I have also read various patient blogs. Some get poor results from these shots. With a percentage of patients going to surgery, no surgeon has ever told me that there is damage. Wish I could be 100% confident, but I believe it is rare. I think if you get the shots, and something goes wrong, you should be ready for the surgery you are trying to avoid with the shots. A true quandry!!. But, it does make me soul search, as I never want anyone hurt. That is why I try to read and go to seminars, etc. Here is the article, and we can talk some more before I give you any more shots. Rich

https://www.ajronline.org/doi/full/10.2214/AJR.06.1463

    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 any variations of nerve alignments, so how close do you have to be? I feel secure that our surgeons, and MRI imaging, has never found damage post shots to my knowledge. And, for this topic, I always look or always ask. Rich

See several of my articles on Morton's neuromas attached:

http://www.drblakeshealingsole.com/2010/08/mortons-neuromas-which-shots-to-get.html

http://www.drblakeshealingsole.com/2011/05/evaluation-of-possible-mortons-neuromas.html

http://www.drblakeshealingsole.com/2015/01/mortons-neuroma-general-principles.html

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.