The treatment of intermetatarsal neuromas with 4% alcohol sclerosing injections

Cryogenic neuroablation for the treatment of lower extremity neuromas

A prospective study testing the efficacy of cryosurgery on lower extremity neuromas was performed. Thirty-one neuromas in 20 patients were percutaneously denervated using a Westco Neurostat-III cryoneedle. All patients were surgical candidates who had failed prior conservative treatment. Patient evaluation consisted of a 10-point visual analog scale (VAS) that was administered pre- and postoperatively. Periodic evaluation with the VAS and patient satisfaction was conducted for a 1-year period following the procedure. Immediately after the procedure, all patients reported complete relief of pain and were permitted to return to full activity. Two weeks after the index procedure, patients were categorized into one of three groups: those who remained completely pain free (38.7%), those who had reduced pain (45.2%), and those who had reverted to preprocedure pain levels (16.1%). The pain score of those patients who had reduced pain decreased from a mean of 8.5+/-0.4 preprocedure to 3.5+/-0.4 (p < .002). All five patients with no improvement had previous local neurectomies. Even though fewer than 40% of the patients had complete pain relief, an overwhelming 90% stated they would have the procedure performed again. Cryogenic neuroablation appears to be a viable treatment option for patients with lower extremity neuromas. The success rate is similar to surgical excision with little to no disability period and high patient satisfaction.