I found this info ....
http://www.zfootdoc.com/neuromas.htm
Dr. Zapf, Since you wrote that article what has changed?
The biggest change is that traditional surgery is no longer required to treat a neuroma. Instead I have found another way to treat a neuroma: sclerotherapy. Sclerotherapy for neuromas involves a series of injections of an alcohol solution into the nerve. I know this sounds painful, and it is to some extent, but for many people it is preferable to an open surgery.
What are your current thoughts on neuroma treatment?
A neuroma is a benign (but very painful) swelling of a foot nerve. I recommend doing one of two things to get rid of the pain: shrink the nerve or kill it.
How do you shrink the nerve?
Cortisone (corticosteroid) injections work to help your neuromas in two ways. First they stop or reduce the inflammation response. As your neuroma gets squeezed between the metatarsal of your foot it becomes quite inflamed. Injecting a little cortisone around the nerve can halt the inflammatory process, at least for a little while.
Second I can harness the ability of cortisone to destroy tissues and use it against the neuroma. too many cortisone injections into one area can cause the local tissues to atrophy and shrink. How many is too many? Nobody knows! Certainly 50 are too many. But probably 10 spaced out over 2 years wouldn't be. To be on the save side there is a rule of thumb (rule of toe?) that we only give three injections of cortisone into any one location. I like to space the injections two weeks apart so I can observe the tissues involved and se if there are any visible changes. This Rule of Three is widespread in medicine. Your doctor probably believes in it too. Funny thing is your doctor has no idea where the rule came from. It is not written in any books on surgery, medicine or pharmacology. It is an idea that just sort sprang full-grown in medicine and is thoroughly lodged there. In most instances I abide by it too. But I have been known to cheat with a fourth or fifth in certain circumstances if the patient and I feel the potential rewards are worth the risks.
There is a funny thing about cortisone injections. Sometimes they completely "cure" a neuroma. I tell my patients that I expect about 5% of neuroma patients to be permanently cured of their neuroma forever with the first injection, 5% more with the second and an additional 5% with the third. There is very little risk involved in any of the first three injections. You body absorbs the cortisone and any effect it might have on your system is over in a day or two. The effect on the neuroma can last for a much longer time. Because the injections of cortisone are of so little risk and up to 15% of people can have their neuroma "cured" forever I strongly recommend every neuroma patients try a couple of injections. A number of people have a fear of cortisone but I feel for the most part that these fears are unfounded. If patients refuse, of course, I work around it and do not force them to have one.
If shrinking a neuroma doesn't help, how do you kill it?
You can kill a neuroma either by surgically cutting it out or with a series of alcohol injections, called sclerosing.
Tell me about sclerosing.
Sclerosing involves 8 weekly injections of alcohol into the base of the neuroma. Each injection involves putting in about 1/2 a CC of a 4% alcohol solution into the skin, moving the needle to the neuroma and depositing the small quantity of the solution. The needle used in the smallest made, a 30-gague, and the syringe is a tuberculin syringe with produces very little painful pressure. To do the injection you put the needle in and move it around the nerve until the patients says something like "Doc, you have found my neuroma."
Sclerosing seems to have no complications except that it sometimes does not work.
For more information on sclerosing see; -->
For Karen's thoughts about sclerosing see -->
For more information on my "painless" injections see --->
One patient's comments on sclerosing:
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!"
What is involved in regular neuroma surgery?
Neuromas can be surgically removed in either the office or the surgery center. The advantage of the surgery center is the use of sedation, which can relax the patient while I am playing with their big, fat foot nerve. Through an incision on the top of the foot the nerve is carefully dissected and removed from the foot. There are a few sutures to close the wound and we are done. Patients return home in an hour or so and need to remain with their foot elevated for three days. During these three days they can walk to the bathroom and go to the kitchen for juice or toast but should not stand to cook, clean or work. After three days they can be as active "as their foot will let them" and within reason. Pain is minimal and usually only a few pain pills are ever taken (after all the nerve that transmits pain signals is sitting in a bottle.) After two weeks of wearing a surgical shoe the sutures are removed and "regular" shoe wearing and regular bathing can be performed.
How successful is regular neuroma surgery?
If by "regular surgery" you mean the traditional procedure whereby a two-inch incision is made on the top of the foot with the removal of the surgery, it is very successful. In 14 years I have probably excised 100 neuromas.
Most are like Michelle S. who said" After suffering with stabbing pains through my toes for years, I decided to do something to change the situation. After several injections of cortisone and sclerosing injections I still had pain. I decided to pursue the surgical treatment. I can't tell you how easy this procedure was! A couple of hours at the SurgiCenter with very professional people, a weekend with my foot raised and the pain was gone! Why did I wait so long? I highly recommend the surgery with Dr. Zapf. I felt I was in very capable hands!"
And Becky who said: "I went into the SurgiCenter early in the morning and was home before I knew it. I have had no pain; really I have had very little discomfort (the worst thing is the surgery shoe that doesn't match anything in my closet). Dr. Zapf and his staff have been great and the staff at the SurgiCenter was also great. It is two weeks since the surgery and I am doing fine. If I had known it was going to be so easy I would have had both beet done at the
same time.
Becky
What can go wrong with regular surgery?
Complications from the surgery include the usual things like complications or allergic reactions to anesthesia, infection of the wound, slow healing of the wound and more pain than expected. In addition there are some things that are specific to neuroma surgery.
There can be an unusual swelling in the space where the neuroma was removed. This is thought to be from the blood that can accumulate in the space where the neuroma used to reside. If there is a lot and early this "hematoma" can be squeezed out, usually with a little anesthesia. If it just a tightness in the area after surgery it can be injected with a bit of cortisone to shrink the tissues. Sometimes just "tincture of time" takes care of it.
The most feared complication is stump neuroma formation. This occurs when little sproutlets of nerve from the cut end of the nerve start to grow trying to heal itself. These sproutlets can grow into a ball that hurts like (or more than) the original neuroma. Rarely these sproutlets seem to grow across the entire neuroma site and reform a neuroma. I say this because a few times I have had the opportunity to go back into the foot to remove a so-called recurrent neuroma and found an entire intact neuroma. This is not supposed to happen if the nerve was properly removed the first time. In some cases i knew of the doctor who did the first neuroma excision and he or she has a great reputation. I am sure that they would have seen a neuroma and would have entirely removed it. So it must have grown back. I have not yet had this happen to me, I don't think, but I have only practiced for 15 years. It can take dozens of years for them to become symptomatic. My time will come, I suspect.
In short I believe that only 2% of the time are people worse off after neuroma surgery. I explain that that is not a reason to avoid the surgery. My belabored analogy: it is like planning an outdoor June wedding in California. There is a 2% chance it will rain. If it rains you are worse off. The fact that it rained did not mean you made a mistake in planning an outdoor wedding. You played the odds and had bad luck. If you want to minimize your odds of something going wrong, don't get married. If you planned an indoor wedding you might get an earthquake (this is California, after all). Then again, single people have shorter lives and more sickness, so pick you poison. In other words, don't let a small chance of a complication ruin an otherwise good decision. If you are really worried about your neuroma surgery and do not want to face the 2% consequence, try sclerosing first. It may not help but it cannot hurt. Then at least if you are a 2%'er you can say you did all you could to minimize your risks.
Neuroma - Nerve Problems in Feet 
