Destruction by neurolytic agent; plantar common digital nerve
CPT4 code
Name of the Procedure:
Destruction by neurolytic agent; plantar common digital nerve
Common Name(s): Nerve ablation for Morton's neuroma
Summary
A treatment involving the destruction of a portion of the plantar common digital nerve using a neurolytic agent. This procedure aims to relieve chronic pain caused by conditions like Morton's neuroma by disrupting the pain signal pathways.
Purpose
The procedure is primarily used to alleviate chronic pain in the foot, particularly pain associated with Morton's neuroma, which is a benign growth of nerve tissue typically located between the third and fourth toes. The objective is to provide long-term pain relief and improved foot function.
Indications
- Persistent, severe pain or burning sensation between toes
- Numbness or tingling in toes
- Pain that exacerbates with walking or standing
- Diagnosis of Morton's neuroma unresponsive to conservative treatments (e.g., shoe modifications, corticosteroid injections)
Preparation
- Pre-procedure consultation to review medical history and evaluate the severity of symptoms
- Potential imaging tests like ultrasound or MRI to locate the neuroma
- Fasting for 6-8 hours if sedation is planned
- Discontinuation of certain medications, such as blood thinners, as advised by the physician
Procedure Description
- Preparation:
- The patient is positioned comfortably, usually lying down.
- The affected foot is sterilized and prepped.
- Anesthesia:
- Local anesthesia is applied to numb the region.
- Sedation may be provided if necessary.
- Procedure:
- A fine needle is inserted into the area around the plantar common digital nerve under imaging guidance (ultrasound or fluoroscopy).
- A neurolytic agent, such as alcohol or phenol, is injected through the needle to chemically ablate the nerve.
- Needle is removed, and a sterile bandage is applied.
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
The procedure is performed in an outpatient clinic or a surgical center.
Personnel
- Podiatrist or orthopedic surgeon
- Radiologist (if imaging guidance is used)
- Nurse or clinical assistant
- Anesthesiologist (if sedation is involved)
Risks and Complications
- Pain and swelling at the injection site
- Infection
- Nerve damage
- Allergic reaction to the neurolytic agent
- Incomplete pain relief or recurrence of symptoms
- Temporary numbness or tingling
Benefits
- Significant pain relief that can improve mobility and quality of life
- Minimally invasive with a relatively quick recovery time
- Alternative to surgical intervention
Recovery
- Post-procedure monitoring for a short period
- Rest and limited activity for the first 24-48 hours
- Application of ice packs to reduce swelling and pain
- Over-the-counter pain medication as needed
- Follow-up appointments to assess effectiveness and need for additional treatments
Alternatives
- Conservative methods like orthotics, physical therapy, or corticosteroid injections
- Surgical removal of the neuroma (neurectomy)
- Radiofrequency ablation Pros: Less invasive than surgery, quicker recovery Cons: May not be a permanent solution, varying degrees of effectiveness
Patient Experience
During the procedure, patients will feel minimal discomfort due to local anesthesia, but some pressure may be felt when the needle is inserted. Post-procedure, mild pain and swelling can be expected, managed with rest, ice, and pain medications. Long-term improvement should be noticeable within a few weeks, while some may experience immediate relief.