The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections

The cause of intermetatarsal neuromas or intermetatarsal neuritis is unclear; however, the most likely pathogenesis is either a mechanically induced degenerative neuropathy or entrapment of the intermetatarsal nerve as it passes under the transverse intermetatarsal ligament. Treatment of intermetatarsal neuromas includes the very simple method of changing shoe styles, more complex conservative treatments with functional orthotic devices, oral anti-inflammatory medications and cortisone injections, and surgical intervention. In this study, 100 adult patients with previously untreated intermetatarsal neuromas received three to seven injections of a 4% alcohol sclerosing solution every 5-10 days. No additional treatment was provided during the visits. The use of 4% alcohol sclerosing solution showed an 89% success rate. Of the 89 patients who were improved, 82 had complete resolution of symptoms. Eleven patients showed no improvement. The results of this prospective study indicate that the alcohol sclerosis treatment of intermetatarsal neuromas is a viable alternative to serial steroid injections or surgery for persistent symptoms.