Cryosurgery Or Sclerosing Injections: Which Is Better For Neuromas?

Reviewing Results, Potential Limitations And Contraindications Of Cryosurgery
The majority of patients obtain complete relief or significant improvement following cryosurgery. All of my patients who have had cryogenic neuroablation have maintained full motor function with no greater loss of sensation than they had prior to the procedure. The results from this procedure are not considered permanent but, in my experience, some of my patients have reached the three-year mark with no recurrence of neuroma pain.
When no relief occurs, it is usually because of dense scar tissue related to a previous excision of the neuroma.7 Performing a percutaneous adhesiotomy or inserting the cryoneedle through the plantar aspect of the foot can overcome this obstacle.
Another limitation of this procedure appears to be the size of the neuroma and excessive fibrosis from previous neurectomy. If the neuroma is 3 cm diameter or greater, the 1 cm ice ball may not be able to penetrate the entire mass.
In my experience, patients with very large neuromas and excessive scar tissue have also failed all previous treatment including alcohol injections.
There is a very low incidence of complications associated with cryosurgery. Infections are rare as is abscess formation at the incision site. However, since cryosurgery involves very cold temperatures, one should avoid performing this procedure for patients who have peripheral vascular disease and conditions such as Raynaud’s phenomena.

Final Notes
Cryogenic neuroablation is a very safe, minimally invasive procedure that one can perform in the office and achieve very good relief of Morton’s neuroma pain. The postoperative recovery period with this procedure is short as patients only need to reduce activity for two to three days. Unlike alcohol injections, the procedure is not painful and patient acceptance is excellent.

Dr. Fallat is a Clinical Assistant Professor within the Department of Family Medicine at the Wayne State University School of Medicine in Detroit. He is the Director of Podiatric Surgical Residency for the Oakwood Healthcare System in Dearborn, Mich. Dr. Fallat is board-certified by the American Board of Podiatric Surgery and is a Fellow of the American College of Foot and Ankle Surgeons.

References

1. Dockery GL, Nilsson RZ. Intralesional injections. Clin Podiatr Med Surg 1986; 3:473-485.

2. Gudas CJ, Mattana GM. Retrospective analysis of intermetatarsal Neuroma excision with preservation of the transverse metatarsal ligament. J Foot Surg. 1986; 25:259-463.

3. Bradley MD, Miller WA, Evans JP. Plantar Neuroma: analysis of results following surgical excision in 145 patients. South Med J 1976; 69:853-845.

4. Davies E, Pounder D, Mansour S, Jeffery, I.T.A. Cryosurgery for chronic injuries of the cutaneous nerves in the upper limb. JBJS Vol. 82-B No.3. April 2000; p 413-415.

5. Barnard D, Lloyd J, Evans J. Cryoanalgesia in the management of chronic facial pain. J. Maxillofac Surg. 1981;9: 101-102.

6. Zakrzgwska JM, Nally FF. The role of cryotherapy (cryoanalgesia) in the management of paroxysmal neuralgia: A six year experience. Br J Oral Maxfac Surg. 1988; 26:18-25.

7. Caporusso EF, Fallat LM, Savoy-Moore R, Cryogenic Neuroablation for the Treatment of Lower Extremity Neuromas. J. Foot Ankle Surg. 41;286-290, 2002.

Reviewing the literature and sharing pearls from his own experience, the author says sclerosing injections can be effective for treating intermetatarsal neuromas.

By Charles F. Peebles, DPM

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