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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

25.10. - 28.10.2016, Berlin

Alcoholization of Morton's neuroma under MRI, fluoroscopic and electroneurographic guidance

Meeting Abstract

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  • presenting/speaker Christof Pabinger - Medizinische Universität Innsbruck, Innsbruck, Austria
  • Isabella Malaj - Medizinische Universität Graz, Graz, Austria

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocWI46-138

doi: 10.3205/16dkou328, urn:nbn:de:0183-16dkou3283

Veröffentlicht: 10. Oktober 2016

© 2016 Pabinger et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Morton's neuroma is a common cause of fore foot pain. Operative results (surgical excision of an interdigital neuroma in patients with refractory conservative treatments) show 77% good and excellent results at a follow-up of 15 years. Conservative treatment with orthotic devices and injections of steroids, Botulinum Toxin, Phenol and Alcohol show good and excellent results in 0 to 84%. All conservative studies cited used only one diagnostic regimen to localize the Morton's Neuroma before an operative intervention.

We wanted to assess outcome of conservative therapy (injection of 70% Alcohol) using three diagnostic regimens (MRI, electroneurography, fluoroscopy) to localize the neuroma in each patient.

Methods: 15 patients with MRI confirmed Morton neuromas were prospectively enrolled between 2010 and 2015 after power analysis according to the relevant laws using predefined inclusion and exclusion criteria.

First using MRI the localization of the Morton's neuroma in relation to the adjacent metatarsal heads was measured. Second, using fluoriscopic guidance, the needle is then positioned according to the measured distances. Third, electroneurographic confirmation and fine adjustements if necesary is done. Fourth, 2.5ml of 70% ethylalcohol are administered and, 5ml of a local anesthetic (2% Xylocain) subsequently.

Postoperative regimen consisted of elevation, and ice packs and a single dose of 500mg Mefenamic acid (Parkemed(R)). VAS, AOFAS and SF 36 were assessed.

Level II Study (prospective, cohort study).

Results and Conclusion: All patients had Morton's Neuroma IIII/IV. Mean follow up was 2 years. All 15 patients were free of symptoms after the last injection up to now. Significant improvement was seen in all scores.

Every patient was able to work without restrictions on the first postoperative day.

Since operative treatment of MRI verified Morton's neuroma has major disadvantages (swelling, no immediate return to work) a conservatice approach seems desireable. All published papers on non-operative methods demonstrate suboptimal results with remarkable disadvantages (poor localisation, recurrence, skin necrosis, swelling, poor outcome of up to 15%). The majority of authors recommend more than 1 injection. All authors used only 1 technique to localize the Morton's neuroma prior to injection.

In contrast, we used three complementary techniques to localize the Morton's Neuroma.

Our results are statistically sound and robust and show significant improvement in 14/15 cases (1 technical defect) after the first injection and in 15/15 cases after re-injection of the failed case. All patients are free of symptoms up to now.

Limitations of our study are the small sample size and the short follow up of only 2 years. Another limitation is, that we did not perform an MRI at the latest follow up examination.

We therefore recommend further long term studies with more patients to assess our method in more detail.