BACKGROUND: Morton's neuroma is a common cause of forefoot pain. Various 
conservative methods (injections of various pharmacologic agents) have been 
published with an outcome of 6%-75% success rate (free of pain in daily life) 
per injection. The aim of the present study was to assess the outcome of an 
improved localization technique, a higher dosage, and a higher percentage of 
ethanol.
METHODS: Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% 
ethanol were injected into 33 feet with a magnetic resonance imaging 
(MRI)-verified neuroma. We evaluated patients at up to 5-year follow-up.
RESULTS: A "success rate" of more than 82% per single injection (defined as free 
of pain in daily life) was achieved and no recurrence was seen over 5 years. All 
scores (visual analog scale; Short Form-36 subscales, American Orthopaedic Foot 
& Ankle Society ankle-hindfoot score) showed significant improvement (P < 
.0001). Mean 1.2 injections were necessary. No significant side effects were 
seen. However, some mild pain persisted in some patients who participated in 
sports.
CONCLUSION: The injection of 2.5 mL of 70% ethanol under fluoroscopic and 
electroneurographic guidance was a safe method for the treatment of MRI-verified 
Morton's neuromas. Combining the effect of a higher percentage of alcohol and a 
higher dosage and an improved localization technique resulted in a high rate of 
patients without pain.
LEVEL OF EVIDENCE: Level IV, cases series, prospective.