The outcomes appear to be similar to, or even more reliable than, alcohol injections, especially if the procedure is performed under ultrasound guidance.A 2019 systematic review of randomised controlled trials found that corticosteroid injections or manipulation/mobilisation reduced pain more than control, extracorporeal shockwave therapy or varus/valgus foot wedges (which did not reduce pain more than control or comparison treatment, and pain reduction was not reported in any wider foot/metatarsal padding studies). The review also found no randomised controlled trials for sclerosing alcohol injections, radiofrequency ablations, cryoneurolysis or botulinum toxin injections. These treatments have only been assessed with pre-test/post-test case series, which do not measure the benefit of treatment beyond any placebo effect, sham treatment or any natural improvement over time. Surgery
If non-surgical interventions fail, patients are commonly offered neurectomy, a surgery that involves removing the affected piece of nerve tissue. Postoperative scar tissue formation (known as stump neuroma) can occur in approximately 20–30% of cases, causing a return of neuroma symptoms. Neurectomy may be performed using one of two general methods. Making the incision from the dorsal side (the top of the foot) is the more common method but requires cutting the deep transverse metatarsal ligament that connects the third and fourth metatarsals in order to access the nerve beneath it. This results in exaggerated postoperative splaying of the third and fourth digits (toes) resulting from the loss of the supporting ligamentous structure. This has aesthetic concerns for some patients and possible, though unquantified, long-term implications for foot structure and health.
By doing so, they increase heart rate and conduction velocity. History
The name atropine was coined in the 19th century, when pure extracts from the belladonna plant Atropa belladonna were first made. The medicinal use of preparations from plants in the nightshade family is much older however. Mandragora (mandrake) was described by Theophrastus in the fourth century B.C. for treatment of wounds, gout, and sleeplessness, and as a love potion. By the first century A.D. Dioscorides recognized wine of mandrake as an anaesthetic for treatment of pain or sleeplessness, to be given prior to surgery or cautery. The use of nightshade preparations for anesthesia, often in combination with opium, persisted throughout the Roman and Islamic Empires and continued in Europe until superseded in the 19th century by modern anesthetics.Atropine-rich extracts from the Egyptian henbane plant (another nightshade) were used by Cleopatra in the last century B.C. to dilate the pupils of her eyes, in the hope that she would appear more alluring. Likewise in the Renaissance, women used the juice of the berries of the nightshade Atropa belladonna to enlarge their pupils for cosmetic reasons. This practice resumed briefly in the late nineteenth and early twentieth century in Paris.The pharmacological study of belladonna extracts was begun by the German chemist Friedlieb Ferdinand Runge (1795–1867). In 1831, the German pharmacist Heinrich F. G. Mein (1799-1864) succeeded in preparing a pure crystalline form of the active substance, which was named atropine. The substance was first synthesized by German chemist Richard Willstätter in 1901.