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Cortisone Vs. Sclerosing for Neuroma Treatment

Neuromas generally occur in the foot. Often referred to as Morton's neuroma, they are noncancerous tumors composed of nervous tissue. They occur when movement in two metatarsal bones (often the 3rd and 4th) irritate the nerves between them. Neuromas cause numbness and shooting pain in the forefoot and can cause limping and heel spurs if left untreated. About 70% of neuroma patients are relieved from their discomfort by wearing custom orthodics. For the other 30%, there are two nonsurgical treatments that are often the podiatrist's next course of treatment, cortisone injections and sclerosis injections.

  1. Understanding the Purpose

    • The major difference between the cortisone injection and the sclerosis injection is how it affects the neuroma. Cortisone is a steroid that is commonly used to reduce inflammation. In the case of a neuroma, cortisone is injected around the neuroma to reduce the nerve swelling and relieve the pressure. It is not intended to cure this condition; however, these injections are meant to shrink the neuroma so that it is no longer painful.

      Sclerosis injection is a diluted alcohol solution which is injected near the site of the neuroma. These injections are often called chemical surgery because of their effectiveness in reversing the neuroma. They are administered to destroy the painful nerve bundle inside the neuroma, while keeping the outer walls intact to promote normal nerve regeneration.

    Knowing the Success Rate

    • Patients taking either sclerosis or cortisone injections should expect to visit a podiatrist for multiple treatments before achieving relief. Sclerosis injections can render a neuroma sufferer pain free in 3 to 6 treatments once weekly or biweekly. While cortisone injections are more potent, patients should expect relief in 2 to 3 injections.

      Because of the lower number of dosages necessary for results, podiatrists offer the cortisone shots as the first line of treatment. The success rate of cortisone injections is about 15 to 20%. Alcohol or sclerosis injections have a much higher success rate. Studies and patient experience has sited 60 to 90% success rate, if the podiatrist is experienced.

    Reviewing Possible Complications

    • As with any treatment, there are risks when choosing either cortisone or sclerosis injections. Most patients have mild or no adverse affects from these injections aside from increased, temporary pain immediately following the doctor's visit, but it is important to take these possibilities into consideration. Sclerosis injection may result in ulceration of the skin at the injection site, swelling of tendons, or stiffened joints. Cortisone injections can cause discoloration or bleaching of skin at the injection site, atrophy of surrounding muscle and bone, and thinning of the foot pads when overused.

    Things to Remember

    • It is important to get diagnosis and treatment for a neuroma. Early treatment will result in a shorter recovery time. Patients need to work together with their doctors to create a plan that will best serve them. It is never a bad idea to be an informed patient and voice questions and concerns at a visit. It is also important to make sure to choose a podiatrist with the neuroma knowledge and experience to make the healing process as expedient as possible.

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