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Saturday, June 1, 2013

Neuroma Injections: Questions regarding Alcohol shots

Hello Dr. Blake,
I have a neuroma in my right foot. Had three cortisone injections and they did not work. I will be getting my fifth alcohol injection this afternoon. The pain is about 75% gone. What would you recommend I do next if today's injection doesn't get me to 100% relief? And how long should I wait to judge the overall effectiveness of the alcohol shots?
Thanks very much.

Dr Blake's comment: 

     Thank you so very much for your comment on my blog. Whereas cortisone shots are typically done as sparingly as possible (three is a good number to try), alcohol shots are done in series of 5 one week to 10 days apart. The goal of the alcohol shots are to decrease the nerve sensitivity and hopefully destroy the nerve (in this area you only lose a small amount of sensation between the toes and no motor function loss). 

     The goal of any treatment modality (and this applies here) is to reduce the pain 80% where the pain level can be maintained day to day between 0-2. 80% better is where you can increase your activity gradually. You still need protective inserts to off weight the nerve (some form of orthotic device or one of the many variations of metatarsal pads). It sounds like you are probably there, or close enough. I would continue icing 3 times a day for 10 minutes each, and continue not to go barefoot. Give the month of June 2013 as a test to see what really happened with those 5 alcohol shots while you gradually increase your activity and give the tissue injected a rest. 

     When you go through the month, you should also consider Neuro Eze or another compounding gel to massaged 3-4 times daily to keep the nerve calm. By 7/1/13 you will have an idea where you are at. If you are alot better overall, but the pain level has gradually increased, you are a candidate for another series mid July to late August--lucky you. In my practice, when I am using alcohol 50% need a second round, and 10% need a third round. And, the bigger the neuroma on MRI, the less likely the shots will work totally--but I would always do before considering surgery. 

     I sure hope this helps. Rich

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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.