Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions.

PURPOSE: 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. MATERIALS AND 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.

Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure.

BACKGROUND: Charcot neuroarthropathy is a serious complication associated with diabetic neuropathy. This complication probably is most serious when the ankle is involved because of the instability and progressive deformity, which often leads to ulceration, osteomyelitis, and amputation. Arthrodesis before the ulcerated lesion appears is considered a limb salvage treatment. One of the most effective techniques for an unstable ankle in Charcot neuroarthropathy is retrograde transcalcaneal nailing. METHODS: Eighteen diabetic patients, without a history of ulceration, were treated from July, 2003, to November, 2005, with panarthrodesis of the ankle using intramedullary retrograde transcalcaneal nailing. The average follow up was 14 +/- 10.1 months. All patients completed the unloaded postoperative period with a fiberglass cast (3 months nonweightbearing and 3 months partial weightbearing) and commenced walking in shoes with a stiff rocker sole and a molded insole. RESULTS: During the followup period there were no major complications. In three patients, removal of one of the proximal screws used for anchoring the nail to the tibia was done because of protrusion causing skin breakdown. Fourteen patients had a stable fusion and four patients had fibrous union. The percentage of limb salvage was 100% in the followup period. CONCLUSIONS: Our study confirms that this operative technique is effective and safe.