title: Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome.
  
  
  METHODS
  Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15-24).
  
  
  RESULTS
  We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients.
  
  
  CONCLUSIONS
  Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.
authors.affiliation: Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy. lucipe@libero.it.
authors.forename: Luciano
authors.initials: L
authors.lastname: Perini
authors.affiliation: Department of Gastroenterology, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Perini
authors.affiliation: Department of Neurological and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Tagliapietra
authors.affiliation: Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Varotto
authors.affiliation: Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Valcarenghi
authors.affiliation: Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Postorino
authors.affiliation: Foot and Ankle Unit, Policlinico Abano Terme Private Hospital, Piazza C. Colombo 1, Abano Terme, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Volpe
mesh_terms: D000203:Activities of Daily Living; D015897:Comorbidity; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D000070607:Morton Neuroma / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000431:Ethanol
keywords: Absolute alcohol; Diseases; Intralesional injection; Neuroma; Peripheral nerve; Ultrasound