What About Cryosurgery For Interdigital Neuritis?

   Babak Baravarian, DPM, first of all, I want to say I always find your articles very educational and informative. As a CryoStar cryoanalgesic certified podiatrist with over 100 clinical cases under my wings, I wanted to add my spin on interdigital neuritis to your perspective (see “How To Diagnose And Treat Interdigital Neuritis,” page 67, January issue).    The use of cyroablation for treatment of Morton’s neuromas received FDA approval in June of 2003. With my colleague, Lawrence Fallat, DPM, and the other 19 CryoStar surgeons, we have treated well over 1,000 neuromas as a collective group. We have close to a 90 percent success rate with one seven-minute in-office treatment.    The advantage of our technique is that it causes no postoperative neuritis or neuralgia. By freezing with nitrous oxide at these temperatures, we are causing a conduction block, similiar to what a local anesthetic does to the nerve but with a greater period of relief. The extreme cold will destroy the endoneurium. However, the epineurium and perineurium remain intact. There is little to no post-op discomfort and patients can be totally asymptomatic within five days.    Granted, there is a place for all forms of treatment. However, in the literature I have reviewed and after speaking with surgeons who are performing the KobyGard and endoscopic decompression of intermetatarsal neuroma (EDIN) procedures, they do not get the level of success that we get with cryosurgery. I have performed many procedures on patients who have had failed intermetatarsal ligament releases but I feel these releases only treat a symptom and not the true root of the problem. Certainly, many of the large neuromas we treat do not seem to respond to these releases. Steroid injections are a temporary fix.    I am not stating that cryosurgery is the only way to treat the problems but with the numbers and results we are getting, we certainly can make a good case for our technique. — Steven H. Goldstein, DPM, DABPS stevefootdr1@cs.com

Dual Degrees May Not Benefit DPMs

   I would like to thank Podiatry Today for offering a dissenting view to the push for the dual degree. (See “Should We Add ‘MD’ To Our Credentials?,” page 74, September 2004 and “Revisiting The DPM/MD Debate,” page 16, November 2004.) What happens when these graduates (with dual degrees) begin to go into the communities and advertise themselves as the best trained physicians for the foot and ankle? How do the existing DPMs compete with that? Some will get by on their fine reputations but others will find themselves sunk.    Let’s face it. Patients are often drawn to the doc who promises the most even if they cannot deliver. How will these new graduates present themselves? Will they present themselves as podiatrists or MDs/DOs? Most likely, they will flip-flop to whatever will serve them best at the time. In other words, for a listing in the phone book, they may be podiatrists. To get on a board or a certain committee, they may present themselves as DOs. This will only confuse the public and a medical profession who are just now understanding what we do.    How long will it be before the insurance plans exclude DPMs and only allow this new breed (who will not be calling themselves DPMs) to treat their members? I have been out of the Ohio College of Podiatric Medicine (OCPM) for 11 years and still have student loans. How am I to go back to school to increase my degree? Who will the APMA lobby for if it even exists in 10 to 15 years? I think it is a breech of trust that the schools will be saying to the public, “Sure, we graduated DPMs but this newly degreed doctor is better.”    Lastly, why does anyone believe these new graduates with an MD or DO are going to limit themselves to treating nails and calluses? When they discover that there are better paying and easier procedure codes, they will go there. — Duane Dumm, DPM podtoo@aol.com

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