A Cryosurgery Update for Foot and Ankle Pain

Cryosurgery or cryoanalgesia is a form of treatment for relief of painful foot and ankle conditions. All pain, regardless of the condition, is related to the nerves of the foot and ankle. This includes a neuroma, heel pain, neuropathy, injuries etc. While cryosurgery has been actively used by many specialties for about 30 years, it is gaining popularity due to its success in relieving pain and the patient’s rapid return to normal activities. In addition, the procedure is minimally invasive and can be performed in the office with little discomfort. The patient is able to walk out of the office, says Dr. Marc Katz, an experienced cryosurgeon in Tampa, Florida.

Cryosurgery is typically used for those patients that have not had relief from pain associated with neuropathy, neuroma or heel problems. The procedure is also successful for pain associated with an injury, arthritis and for most other foot and ankle pain not relieved by conservative therapy. Dr. Katz reports that many of his patients want to try alternatives to more invasive surgical procedures to get relief. While cryosurgery does relieve pain, some patients may require additional treatments to obtain an acceptable amount of relief or may require periodic treatments for more prolonged relief. However, patients have no hesitation repeating the procedure if it means relief from pain.

Dr. Katz stated that this is another option available to patients giving them more choice when it comes to getting relief. The big advantages include high success, low complications, low cost and little to no down time.

So what exactly happens when a patient has cryosurgery?

Basically, super freezing is applied to the nerve that is causing pain. When controlled freezing and thawing occur, a portion of the nerve will breakdown. This causes a prolonged anesthetic effect and thus pain relief. This occurs because the pain signal to the brain has been disrupted. The physician can then address the underlying cause of problem and correct it to obtain more lasting relief. It is the natural course of healing for the body to attempt re-growth of the nerve. So many patients will receive custom orthotic arch support devices to realign the foot and ankle and allow healing without repeat damage to the nerve.

One major advantage of cryosurgery is that when the nerve heals and new growth forms, there is no occurrence of a stump neuroma. A stump neuroma is a disorderly growth of nerve tissue often resulting in chronic unresolved pain. Since the cryosurgical procedure leaves the outer coating or insulation of the nerve intact, the newly growing nerve has a pathway for orderly growth and allows pain-free regeneration.

Dr. Katz recommends this treatment to his patients before consideration of more invasive procedures. I don’t compare cryosurgery to nerve removal or nerve releases procedures. It’s like comparing apples to oranges! I believe that the procedure should be tried because of its success and it may avoid the need for nerve removal or release. This is a totally different approach to relieving pain and it is the future of pain relief. Why not try the procedure before having the nerve removed? Nerve removal has around a 20% failure rate and a significantly higher complication rate including stump neuroma and chronic pain. Katz says that if he can have a large percentage of his patients avoid a poor outcome it is certainly to the advantage of the patient. In addition, health care costs are decreased since a costly surgery center or hospital visit can be avoided.

Katz also noted that he has patients that have had nerves removed and have developed stump neuromas. He has treated these patients successfully with cryosurgery even after the more invasive procedures. So, there is always a chance for hope and relief.

When it comes to neuropathy, there really are few options with the exception of strong medications that are not well tolerated or just don’t provide relief. While there are procedures for release of tissues around the nerves, many are not candidates to have this invasive procedure or their neuropathy is too severe to obtain success with nerve relief.

The Procedure

There are different methods of performing the cryosurgery procedure. Dr. Katz has developed his own protocol based on his experience and testing techniques to improve the success rate. Currently, the procedure is performed with local anesthesia such as Lidocaine or Marcaine. The probe is accurately placed on the nerve using a high powered vascular ultrasound, visualizing the nerves and blood vessels. In addition, where appropriate and tolerable, a nerve stimulator is used using a modified technique with minimal discomfort. Newer advanced techniques allow for visualization of the nerve with painless freezing and incorporation of the stimulator with minimal discomfort.

Cryosurgery is an excellent safe option for relief of foot and ankle pain. With advances in technology and technique, patients have additional choices available in their treatment regimen. The future of medicine is evolving into minimally invasive methods of treatment. Patients can now take advantage of this cutting edge pain relief technology.