A Closer Look At Cryosurgery For Neuromas
Can cryosurgery be an effective alternative treatment for neuromas? This author offers keys to diagnosis, shares pertinent pearls on cryosurgical techniques and emphasizes the benefits of ultrasound injection guidance.
Cryosurgery or cryoanalgesia is an accepted, well-known treatment within the pain management community. However, its acceptance within the field of podiatry has been slow. With the improvements of nerve visualization using ultrasound, clinicians are using cryosurgery more frequently. Within many specialties, surgeons are performing procedures for pain relief and even for destruction of various types of tumors and abnormal tissues.1
Many medical specialties have embraced cryosurgery for various pain syndromes including post-thoracotomy pain, intercostal neuralgia, inguinal pain, facial pain and facet syndrome. According to Trescot, cryosurgical neuroablation uses are far reaching. He notes that clinical applications range from postherpetic neuralgia in thoracic distribution and craniofacial pain secondary to trigeminal neuralgia to sacroiliac joint pain and persistent pain after rib fractures.2
If other specialties so widely use cryosurgery for so many indications, why is there a reluctance to use this technology in the podiatry community?
Traditionally, physicians performed earlier applications of cryosurgery without the use of fluoroscopy and ultrasound. However, the success rates were lower due to this lack of visualization. In many cases, surgeons had to perform the procedures with direct visualization of structures that required more invasive techniques. Originally, the cryosurgery units were developed with nerve stimulators, which increased the nerve localization percentage and improved the outcome of the procedure. However, in my experience, patients were having too much pain during the procedure for me to adequately assess whether I was truly on the nerve tissue.
Now the trend in medicine is rapidly moving to minimally invasive procedures using various types of guidance. It is my belief that most medical procedures will happen this way in the near future. Currently, many specialties use ultrasound guidance as a standard part of their procedures.3
Is Cryosurgery Still An Option For Neuromas?
According to Trescot, cryoanalgesia is a viable option for small, well-localized nerve lesions such as a neuroma. Long-lasting analgesia may happen with cryosurgery.2
Having performed cryosurgery for about seven years, I strongly believe that cryosurgery remains an excellent treatment option for foot neuromas and other nerve conditions throughout the foot and ankle. The popularity of foot cryosurgery has waned due to the fact that there is currently no podiatry-specific cryosurgery device. However, there will likely be some excellent devices available in the near future that are currently in development.
One factor that hinders the current advancement of cryosurgery is the lack of proper training available to allow physicians to perfect the cryosurgery technique. In the past, many physicians mistakenly believed that since they knew the anatomy of the foot, they did not require any training in cryosurgery. After all, if they could do a neuroma injection and a traditional nerve removal surgery, how could they not be proficient at cryosurgery?