RF of Digital Plantar Nerves

[101N]

Any of you have experience with RF of a plantar nerve either pre or post Morton's excision?
I've got a guy with 1st webspace pain - unusual - s/p 2 previous excisions in the 2nd and
3rd webspaces. The podiatrist is not interested in another excision and so I' think I'm left with
either alcohol neurolysis, RF, or stim.

J Foot Ankle Surg. 2012 Jan;51(1):20-2. Epub 2011 Nov 4.
Radiofrequency Thermoneurolysis for the Treatment of Morton's Neuroma.
Moore JL, Rosen R, Cohen J, Rosen B.


Podiatric Surgical Resident (PGYIII), University Hospital, Newark, NJ.

Abstract
Pedal neuroma is a common disorder. The authors undertook a review of 32 feet in 29 patients with a symptomatic neuroma treated between January 2007 and January 2010 to evaluate the effectiveness of radiofrequency thermoneurolysis therapy in alleviating symptoms. Overall relief of symptoms was rated as complete by 24 (83%) patients, with 5 patients experiencing minimal to no relief. Two patients were lost to follow-up after 1 month, 2 patients opted for no further intervention, and 1 patient went to open resection of the neuroma. Average follow-up was 13 months and total recovery time was 2 days. Complications included 1 foot with cellulitis treated by a course of oral antibiotics. The results of this retrospective study indicate radiofrequency thermoneurolysis therapy is a safe, effective, and minimally invasive alternative treatment for symptomatic neuromas of the foot.

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[Gauss]

sclerosing injections have the same clinical and statistical outcomes

 

[jpb26]

I have done a few (n=4) with excellent results. 2 were after an excision and 2 were on folks who have never had any sx. All 4 of these folks did very well and were happy, 2 are >1 year and the other 2 are only 3-6 mo out. I have to say there was a bit more post procedure pain than I was expecting but even so it only lasted a few days. I've never done the alcohol injections so I can't compare. I think it's certainly a worthwhile procedure.

 

[ghost dog]

Any of you have experience with RF of a plantar nerve either pre or post Morton's excision?
I've got a guy with 1st webspace pain - unusual - s/p 2 previous excisions in the 2nd and
3rd webspaces. The podiatrist is not interested in another excision and so I' think I'm left with
either alcohol neurolysis, RF, or stim.

J Foot Ankle Surg. 2012 Jan;51(1):20-2. Epub 2011 Nov 4.
Radiofrequency Thermoneurolysis for the Treatment of Morton's Neuroma.
Moore JL, Rosen R, Cohen J, Rosen B.


Podiatric Surgical Resident (PGYIII), University Hospital, Newark, NJ.

Abstract
Pedal neuroma is a common disorder. The authors undertook a review of 32 feet in 29 patients with a symptomatic neuroma treated between January 2007 and January 2010 to evaluate the effectiveness of radiofrequency thermoneurolysis therapy in alleviating symptoms. Overall relief of symptoms was rated as complete by 24 (83%) patients, with 5 patients experiencing minimal to no relief. Two patients were lost to follow-up after 1 month, 2 patients opted for no further intervention, and 1 patient went to open resection of the neuroma. Average follow-up was 13 months and total recovery time was 2 days. Complications included 1 foot with cellulitis treated by a course of oral antibiotics. The results of this retrospective study indicate radiofrequency thermoneurolysis therapy is a safe, effective, and minimally invasive alternative treatment for symptomatic neuromas of the foot.

I was under the impression that Alcohol neurolysis was not a good idea , as pts could get some pretty severe side effects (i.e. neuropathic pain).

Why not just RF ?

 

[101N]

AJR Am J Roentgenol. 2007 Jun;188(6):1535-9.
Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases.
Hughes RJ, Ali K, Jones H, Kendall S, Connell DA.
Source
Department of Radiology, Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.
Abstract
OBJECTIVE:
Morton's neuroma is a common cause of forefoot pain. For this study, we assessed the efficacy of a series of sonographically guided alcohol injections into the lesion.
SUBJECTS AND METHODS:
One hundred one consecutive patients with Morton's neuroma were included in this prospective series. An average of 4.1 treatments per person were administered, and follow-up images were obtained at a mean of 21.1 months after the last treatment (range, 13-34 months).
RESULTS:
Technical success was 100%. Partial or total symptom improvement was reported by 94% of the patients, with 84% becoming totally pain-free. The median visual assessed pain score decreased from 8 before treatment to 0 after treatment (p < 0.001). Transitory increased local pain occurred in 17 cases (16.8%). There were no major complications. Thirty patients underwent sonography at 6 months after the last injection and showed a 30% decrease in the size of the neuroma.
CONCLUSION:
We conclude that alcohol injection of Morton's neuroma has a high success rate and is well tolerated. The results are at least comparable to surgery, but alcohol injection is associated with less morbidity and surgical management may be reserved for nonresponders.

 

[Gauss]

and there it is
you're thinking phenol ghost dog

 

[ghost dog]

and there it is
you're thinking phenol ghost dog

Ha ! You are correct sir !

 

[ziggyziggy]

Anyone doing the RF for morton's? What temp are you running and how are the outcomes? Any post RF numbness etc. ?

 

[Agast]

Bumping this because I have a patient who is interested. I’m thinking phenol would be more straight forward than holding a needle in the foot for 90 seconds. Anyone try this?

 

[Ducttape]

i wouldnt use phenol for something so peripheral. it is also more permanent. id do RFA.

 

[Agast]

i wouldnt use phenol for something so peripheral. it is also more permanent. id do RFA.

Have you done one before?

 

[Ducttape]

not mortons.

ive done some peroneal nerve RFA, a few sural nerve and a couple of distal saphenous nerve RFAs. like everything else, +/- success rate.

 

[Baron Samedi]

I did one RFA in fellowship. Patient lost to f/u so no idea on the efficacy but it was an easy enough procedure to perform.

 

[GlowInTheDark]

for these more superficial areas I can’t help but be concerned for developing a deafferentation pain. I’d start with an RFA if anything.

Anyone with some experience either way in these areas?

 

[Ligament]

I've done RF, phenol and EtOH for these. NOT many. If doing RF, don't burn the skin. I've seen that happen (not with me) Place needle through web space parallel to metatarsals. Consider a 0.3mm or 0.5mm active tip. Keep skin monitored, place your hand on it or an ice pack to minimize thermal trauma to the skin.

One phenol patient I did turned that intermetatarsal space to mush, had a lot of post op pain, MRI looked scary, triggered an ID consult. I may have used too much phenol (do not recall the dose).

 

[Agast]

I've done RF, phenol and EtOH for these. NOT many. If doing RF, don't burn the skin. I've seen that happen (not with me) Place needle through web space parallel to metatarsals. Consider a 0.3mm or 0.5mm active tip. Keep skin monitored, place your hand on it or an ice pack to minimize thermal trauma to the skin.

One phenol patient I did turned that intermetatarsal space to mush, had a lot of post op pain, MRI looked scary, triggered an ID consult. I may have used too much phenol (do not recall the dose).

Oo parallel? So enter in between the toes and walk off the os? I'm assuming you did it with ultrasound.

 

[Ligament]

Oo parallel? So enter in between the toes and walk off the os? I'm assuming you did it with ultrasound.

Yes, parallel to the long bones of the foot. You dont really need to walk off os, but just get the tip to the neuroma, if you can visualize it on u/s.

Yes, I did it with ultrasound.

I think if you use a smaller active tip, the parallel technique I'm describing is not that important. I do this to avoid injuring the skin...

Best of luck!