How well does sclerosing for nerves work? read this by a patient names
Karen with a painful neuroma. Read Karen's story at -->
Sclerosing Corns and Nerves
By: Michael Zapf, D.P.M., M.P.H., F.A.C.F.O.
The other day I was trying to explain to a culinary oriented patient something I had
recently learned at a seminar. It was a new (to me) method of treating a variety of
conditions using a concoction consisting of local anesthesia and pure alcohol. I told her
we might consider sclerosing her corn and I spelled the technique,
“s-c-l-e-r-o-s-i-n-g”. “Thank goodness you spelled it”, she replied.
“I thought you said slow roasting.”
Sclerosing has been used for years to eliminate varicose veins without surgery. Using a
variety of agents, this alcohol solution being one, a thick vein is injected with the
sclerosing solution. In effect the solution scars both sides of the vein. When
compression, in the form of an elastic bandage is applied, both sides of the vein scar
together and the vein is closed permanently. Sclerosing has proven to be safe and
effective.
In podiatry we are continually confronted by calluses, called corns, caused by
prominent parts of bone rubbing against other bones or shoes. These corns are
conservatively treated by trimming, padding and changing shoes. Surgery is directed at
reducing the bony prominence. Surgery for corns is very common and very effective.
Sclerosing injections can often eliminate plugged sweat ducts and
neuromas without surgery
A less common type of corn is the porokeratosis or, for the podiatrically challenged, a
“plugged sweat duct” (PSD). They have also been given the name seed corn
because they seem to have a central core that reminds people of a seed. PSDs are usually
found on the bottom of the foot in weight bearing locations. PSDs are not caused by a bony
prominence and there is no easy way to get rid of them forever. The only two choices were
to trim them every few months or to surgically excise them with an incision going through
the whole thickness of the skin. Any such surgery will leave at least a fine scar. Because
scars in a weight bearing location can be as uncomfortable as the corn, surgery is not
often performed. This is where slow roasting, er, sclerosing, comes in. PSD will often go
away with a series of sclerosing injections performed with tiny needles and tiny syringes.
Sutures and bandages are not required.
Sclerosing is also a great way to kill nerves (neurolysis). Killing nerves is not
something to be undertaken lightly. But sometimes, in cases of neuromas or trapped nerves,
for instance, the nerve is the problem. With sclerosing injections the nerve can be
eliminated as a source of pain without surgery.
Sclerosing corns or nerves requires up to seven
or
eight weekly injections. Because injections
have been given a “surgery code” by insurance companies, it will appear on your
bill as a surgery even though you never approached an operating room.
Now you know when your hear me telling you about sclerosing corns, I am not referring
to a summer barbecue.
From The Doctor’s Desk:
It is wonderful when a simple therapy can
take the place of a more involved open surgery. It is even more wonderful when it can
treat a problem that is otherwise untreatable. Such is the story with the annoying problem
known as seed corns, plugged sweat ducts or porokeratotic lesions.
On a hard surface these little lesions hurt - sometimes a lot. Until now, none of our
simple treatments, such as using a wart remover, has not worked. Getting rid of them
permanently has required a full thickness skin excision. Such an incision can leave a
painful scar, especially if a patient walks on it during healing.
I was very happy at a recent seminar to learn about sclerosing injections. It is an old
technique used in a new method. Sclerosing can treat seed corns, neuromas and certain
other conditions. I am happy to offer this to my patients as a non-surgical option in
treating these vexing problems.
Dr. Michael Zapf
---------------------------------------------------------
I received the following letter about
a seed corn April 21, 2001
Dear Dr. Zapf,
It was good to find your web site, it was the only useful information I
was able to find. I have a seed corn under my foot which causes a lot
of pain and because I tend to walk differently on that foot now, causes
shooting pains all the way up my leg, especially when I am laying in bed
at night. In desperation I decided to have surgery in the doctor's
office (I live in the small town of Athens, Ohio). After the surgery I
had stitches in my foot and was on crutches for three weeks. After that
it was great and the shooting leg pains had stopped. Five months later
they came back, that is when I realized the seed corn had returned. Now
I am desperate. You mentioned SCLEROSING, what exactly would that do
for a seed corn? Would it cure it, or just stop me from feeling it?
Thank you.
Susan R.
Dear Susan,
As
you can see from what I wrote above I do use sclerosing as a first step in
treating seed corns before I would ever try to surgically excise them. The
surgery is cumbersome and for best results you need to be off the foot for 3
weeks afterwards. Seed corns seem to occur in little crops of three or four. The
picture at the top of this page shows two seed corns in the middle of a long
"linear" callus. If you successfully remove one of the little guys you
might have a sibling pop next to (or in) the incision site. This new one would
seem to be a recurrence of the original corn but I believe that the surgery
completely eliminated the original and the "recurrence' is really a second
corn. You could, of course, remove this second corn with the same surgery. As an
alternative you can "sclerose' this corn just as you could have sclerosed
the first one. My success of sclerosing seed corns is good but not great. In a
study I did of 32 of my patients I found that they completely resolved (went
away) about 1/3 of the time. In another third they did not go away but the nerve
under them must have been killed because they no longer hurt. I consider this a
success because if they do not hurt most people can live with the little callus
under the foot. Finally in 1/3 of the cases there was no improvement and I would
have to consider the treatment a failure. Keep in mind that a successful treatment
takes a series of 7 or 8 (or sometimes more) weekly injections of a small
quantity of the alcohol solution just under the lesion. I hope this helps
Dr.
Zapf
Another note:
From Jane B. She returned to my office for an
unrelated problem but had her neuroma "sclerosed" 6 years before. She
noted that she had no pain whatsoever from her neuroma since she has the
treatment. She made the following note; "I will always choose an
alternative method to surgery first and Dr. Zapf's special Zapping method for
neuromas, sclerosing, really worked for me!"
