Chronic Plantar Fasciitis: Is Cryosurgery The Answer?
Cryosurgery is the specialized field of using extremely low temperatures (controlled by a handheld probe) to destroy pathological tissue. This technique has been used for decades to treat malignant tumors of the prostate, liver and other organs.1-3 Cryosurgery is also gaining acceptance in dermatology, plastic surgery, urology and pain management.4-6 Now clinicians are using this technology to help manage common foot and ankle conditions.7-9 I have been performing cryosurgery for plantar fasciitis for approximately three years with excellent results. All of my patients who have had this procedure previously tried other treatments, including multiple steroid injections, NSAIDs, orthotics/arch supports and physical therapy, without success. Some have used night splints. Two patients had shockwave therapy, one underwent an endoscopic plantar fasciotomy and another had a percutaneous medial fascial release. After undergoing cryosurgery, approximately 90 percent of the patients had complete resolution of pain or had only minor residual pain that required no treatment. There have been very few complications with cryosurgery. Infection has been rare. The most common sequella has been the development of pain in another location of the heel or arch. This is the result of a postoperative compensatory gait and usually resolves in three to four weeks after the procedure. If patients receive this treatment, this compensatory fasciitis responds well to a course of NSAIDs, low dye taping or over-the-counter arch supports. Although the cryosurgery literature suggests that the analgesic relief with this procedure is temporary, a three-year follow-up has revealed virtually no recurrences of the plantar fasciitis.