Alcohol Injections for Plantar Fasciitis and Neuromas
Dr. Rampertab has performed over 4,000 procedures now and finds that the success rate for certain patients is reasonably predictable. Although the overall success rate for UltrCryo hovers around 97% with those patients relating 100% relief of symptoms, the success rate for patients who have had even a single Alcohol injection drops dramatically to 50-60%.
After treating more than 200 patients with a history of Alcohol injections for the treatment of Neuromas and Plantar Fasciitis, Dr. Rampertab finds that these patients account for the vast majority of patients who see less than optimal relief of symptoms after UltraCryo. Of these 200 or so patients, only a little over half have had complete relief of symptoms after the first UltraCryo. Most of the remaining patients had a repeat UltraCryo procedure and again about half found that they had complete relief of symptoms after the second procedure. Of the remaining 50 or so patients, half were doing well enough that they were satisfied with the remaining pain level. The remaining 25 or so continued to have significant pain. Most of these patients went on to have open surgical excision of the nerve and about half had a satisfactory healing course with minimal symptoms. The remaining dozen or so patients continued to have significant pain.
Dr. Rampertab feels that the reason for these findings is definitely the Alcohol injections and the effects that the Alcohol has on the nerve structure. Dr. Rampertab does not advocate Sclerosing Alcohol treatment for any conditions of the foot. By its definition, (sclerosing means "to turn to bone") alcohol injections cause soft tissue atrophy (shrinkage and hardening). As it is a fluid and fluid flows to the path of least resistance, there is no way to keep the medicine in a particular spot when you inject it. It flows throughout the tissues. This same process of sclerosing causes changes within the nerve tissue including the structures needed for the normal healing of the UltraCryo procedure. This hardening of the surrounding tissues of the nerve cause the freezing to not have a predictable effect on the nerve.
Because of these findings, Dr. Rampertab tries to make patients fully aware of the greater chance of failure of the UltraCryo procedure on patients who have had one or multiple Sclerosing Alcohol Injections. Given that a significant number of those patients did respond favorably with over half being symptom-free after the first procedure, it should still be considered the treatment of choice, but if the first procedure fails and there is very little relief, it may be best to start considering open excision of the nerve.
Dr. Rampertab tries his best to educate other Foot and Ankle Specialists about the adverse effects of Sclerosing Alcohol Injections. More and more Phoenix area DPM's have discontinued the use of Alcohol Injections after discussions with Dr. Rampertab.