Medical University of Innsbruck, Austria.
OPZ Graz, Orthopaedic Private Clinic, Graz, Austria.
Foot Ankle Int. 2020 May;41(5):590-595. doi: 10.1177/1071100720903096. Epub 2020 Feb 4.
Morton's neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol.
Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)-verified neuroma. We evaluated patients at up to 5-year follow-up.
A "success rate" of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form-36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement ( < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports.
The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton's neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain.
Level IV, cases series, prospective.
Morton 神经瘤是引起前足疼痛的常见原因。各种保守治疗方法（各种药物注射）已经发表，每注射一次的成功率为 6%-75%（日常生活中无疼痛）。本研究的目的是评估一种改良的定位技术、更高的剂量和更高的乙醇百分比的疗效。
使用透视和电神经图引导，将 2.5 毫升 70%的乙醇注入 33 只经磁共振成像（MRI）证实的神经瘤的足部。我们在长达 5 年的随访中对患者进行了评估。
单次注射的“成功率”超过 82%（定义为日常生活中无疼痛），5 年内无复发。所有评分（视觉模拟评分；SF-36 子量表，美国矫形足踝协会踝关节-后足评分）均显示显著改善（<0.0001）。平均需要 1.2 次注射。未观察到明显的副作用。然而，一些参加运动的患者仍有一些轻微的疼痛。
在透视和电神经图引导下注射 2.5 毫升 70%乙醇是治疗 MRI 证实的 Morton 神经瘤的一种安全方法。结合高比例的酒精、更高的剂量和改良的定位技术，可使大部分患者无痛。
IV 级，病例系列，前瞻性。
