One of the main challenges that small and midsize businesses face is managing and caring for their employees. Factoring in payroll, taxes and insurance costs, employee-related costs can be one of a company's largest expenses.

In recent years, professional employer organizations have become a viable way for smaller companies to save money on human resources costs. The organization manages all your employee-related functions - payroll, taxes, insurance - cost effectively, freeing you to focus on your business.

Once you hire employees, you are required to pay them a salary, pay unemployment fees and take out workers' compensation insurance. Depending on the number of employees, larger companies normally delegate employee-related functions to a human resources department. But what should a company do when it has too few employees to justify creating a formal HR department?

This problem has given rise to HR outsourcing firms that companies contract with to take over certain employee-related tasks. Outsourcing takes the HR burden off smaller businesses and transfers them to an outside firm that specializes in the various areas of human resources: payroll administration, benefits, and employee orientation and training. The benefits HR outsourcing can offer include:

-- Skilled professionals to do the job.

-- Improved employee relations.

-- Money saved by cutting overall expenses.

The organization takes the concept of HR outsourcing one step further. Rather than specializing in certain areas, it becomes the employer of record, and as such takes on all legal responsibilities for your employees. In practice, it will legally hire all of your current employees, making it responsible for taxes and insurance. When you hire such an organization, you enter into a contract that defines powers, responsibilities and liabilities.

Although sometimes aligned with temporary employment agencies and staff leasing firms, the organization provides a much different type of service. Unlike a temp agency, your employees are intended to be permanent and not moved around to a variety of jobs. In terms of staff leasing, you are not just leasing any employee, you're leasing your own employee. Everything is the same, except that your employee receives paychecks and benefits from an outside firm. The employees still work for you, but all their taxes, benefits and insurance are handled by an outside source.

This can save your company money. For example, you might have the advantages of group insurance. These organizations can do this because they handle a variety of small businesses that they pool together, getting better rates for all the businesses involved. When looking for an organization, do some comparison shopping as to their differing fees and responsibilities.

AllBusiness.com provides information about products and services for entrepreneurs, small businesses and professionals to start, manage, finance and build a business. Visit www.allbusiness.com.

This article appeared on page C - 5 of the San Francisco Chronicle

The shot of alcohol that cures foot pain

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Until now, surgery has been the only effective treatment for the condition, where a small growth forms on a nerve in the foot.

However, a clinical trial has shown that just four alcohol injections straight into the growth work as well as surgery but with none of the risks.

Morton's neuroma occurs on the nerves that run between the long metatarsal bones in the feet.

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A shot of something to make you steadier on your pins: Alcohol is toxic to the nerves, gradually killing off the neuroma and patients have noticed a marked improvement after only two injections

Typically, a small nodule (between 2mm and 20mm) develops in the webbing between the third and fourth toe. The pain is caused by it getting trapped and squeezed between the bones.

The condition is far more common in women, with those aged between 40 and 60 most at risk.

It's thought that tight shoes, high heels, bunions and flat feet are all possible causes, as their effect is to squeeze the bones together, pinching the nerve.

The resulting friction thickens the nerve so that it eventually forms a lump (the neuroma).

Patients initially experience just intermittent stabbing pain - which appears to be linked to spending long periods on their feet.

But over a period of months, the pain can become constant, often radiating as a tingling or numbing sensation in the toes.

Patients describe it as being like walking on a hard pea.

Many also develop a painful clicking in the foot - the sound of the trapped nerve pinging up or down between the long bones.

For years, the first line of treatment was cortisone injections, which work as an anti-inflammatory and can provide temporary relief. But recent studies have shown it is not very effective for managing longer-term pain.

Other measures, such as custom-made footpads (orthotics), designed to relieve pressure on the ball of the foot, can reduce pain for some patients.

But many say these actually make the pain worse as they take up room in the shoe, which squashes the feet even more.

If these steps fail, until now patients have had to resign themselves to the prospect of surgery.

This has a success rate of around 75 to 90 per cent. However, it can fail and specialists say the risks shouldn't be underestimated.

"The neuroma may be removed but the scar tissue that can form, and is a normal part of the healing process, can wrap around the nerve, causing intractable pain," says Dr David Connell, a leading investigator on the alcohol jab trial.

"Or it can cause a 'stump' neuroma - where the nerve grows back." This can be more painful than the original neuroma.

Even if surgery is successful, patients can spend up to six weeks off their feet as they recover.

The new treatment, which is carried out on an outpatient basis, involves four injections spaced two weeks apart.

Alcohol is toxic to the nerves and the jabs work by gradually poisoning and killing off the neuroma.

For the trial, carried out at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, 101 patients received injections containing 20 per cent of alcohol diluted in a local anaesthetic and delivered under ultrasound guidance.

Patients were up on their feet minutes after having the ten-second jab.

The patients' progress was followed for an average of two years, and 84 per cent were reported to be totally pain-free after treatment, while another 10 per cent reported partial symptom relief.

Angela Lombardo, 53, a teacher from London, had the treatment in October after being diagnosed in May. "The injections stung for a few seconds but the improvement was noticeable immediately.

"If I'd had the surgery, I'd have been laid up for six weeks but I went on holiday immediately.

"My husband and I walked non-stop for two weeks and I was completely pain-free."

At the moment, there are only about six consultants using this technique.

But as Ian Reilly, a consultant podiatric surgeon from Northampton General Hospital, explains: "What researchers at the Royal National Orthopaedic Hospital say carries weight. Any good surgeon wants to avoid operating on patients if it is at all possible.

"I think this story will spark a lot of interest from consultants."

• Privately, the four jabs cost about £616. They cost the NHS about £300.

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