1312 - Phenol Chemoneurolysis of Four Morton's Neuromas due to Serial Casting in a Young Adult with Spastic Diplegic Cerebral Palsy

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

AM

Ankur Mathur, DO

Resident
McGaw Medical Center of Northwestern University
Chicago, Illinois, United States

Co-Author(s)

TK

Timothy Krater, DO

Pediatric Rehabilitation Medicine Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States
AO

Ana M. Ortiz-Santiago, MD

Pediatric Rehabilitation Medicine Physician
Instituto de Rehabilitación del Caribe
San Juan, Puerto Rico

Case Diagnosis: Morton’s Neuromas in a 23-year-old female with spastic diplegic Cerebral Palsy status post intrathecal baclofen pump placement, lumbar Selective Dorsal Rhizotomy, and Tethered Cord Release

Case Description: This patient began experiencing shooting pain in the second and third web spaces on her left foot after completing serial casting for plantarflexion contracture. Pain occurred with metatarsal head compression and weight bearing with orthotics. Ultrasound evaluation revealed neuromas in the respective web spaces. After minimal relief with toe spacers and topical diclofenac, she underwent phenol chemoneurolysis of both neuromas using ultrasound and electrical stimulation guidance. She reported complete relief after one day. While donning ankle foot orthoses two days after the procedure, she noticed similar pain in the first and fourth web spaces of her left foot, with associated shooting pain with metatarsal compression. Ultrasound evaluation confirmed two new neuromas in the respective web spaces. After undergoing phenol chemoneurolysis of these neuromas using ultrasound and electrical stimulation guidance, she experienced complete pain relief within one day and was able to tolerate orthotics and weight bearing.

Discussions: Cerebral Palsy patients undergo multiple interventions to help improve their plantarflexion contractures, including serial casting. This case highlights Morton’s neuromas as a possible cause of foot pain after serial casting. While Morton’s neuromas are known to have positive outcomes when treated with steroid injections, phenol chemoneurolysis may be another option to provide symptom relief for these neuromas.

Conclusions: This case demonstrates a rare occurrence of four unilateral interdigital neuromas, which were successfully treated with phenol chemoneurolysis. Future studies may be aimed at comparing outcomes and length of pain resolution between interventions, conservative treatment, and other medication infiltrations.