A Closer Look At Cryosurgery For Neuromas
Other considerations when evaluating a patient would be the abnormal foot structure and motion that likely lead to abnormal stress and neuroma. One should evaluate all patients for orthoses. This is critical considering that the nerve typically does regrow and if it is subjected to abnormal forces, the nerve will likely become damaged, resulting in a recurrent neuroma.
Making The Case For Cryosurgery In Podiatry
One can easily perform this minimally invasive procedure in the office with more rapid recovery postoperatively. I have found that patients have increasing demands on their time because of work and family, and they often request treatment options that require less time off and less recovery. The idea of traditional surgery and the time needed for post-op healing are often undesirable. They also want to return to activities much faster.
One can repeat the cryosurgery procedure if there is recurrence. If the procedure does not provide relief, the patient may still undergo traditional nerve excision or any other types of treatments that may be available.
Cryosurgery is a more cost-effective procedure than taking the patient to an outpatient surgical facility. With future changes in our healthcare system, insurance companies will likely be looking for more cost-effective procedures and relying on physicians to complete treatment courses in shorter time periods.
I do recommend that patients wear a controlled ankle motion walker postoperatively to help ensure adequate offloading and prevent edema. After all, this is still a surgical procedure and requires adequate time for tissue healing. In my personal experience, allowing early ambulation in a regular shoe leads to too much activity and slower healing. Congestion of the area with edema may slow the ability of the macrophages to access the area for more rapid destruction of the nerve.
Cryosurgery for neuromas is an excellent, minimally invasive procedure that should develop further to give practitioners alternatives to traditional surgery. In addition, since podiatrists are the most highly trained physicians of the foot, it only makes sense that our specialty should champion and refine this procedure. Offering improved targeted treatment accuracy and reduced post-op recovery, guided minimally invasive procedures appear to be more in vogue, and cryosurgery fits the bill perfectly.
Cryosurgery is in use throughout various medical specialties, continues to be promising and is often the treatment of choice in the hands of many physicians. I would encourage podiatrists to learn more about this valuable treatment and consider adopting the procedure as part of a comprehensive treatment protocol.
Dr. Katz is in private practice in Tampa, Fla. He is a Fellow of the American Professional Wound Care Association.
1. Adam R, Akpinar E, Johann M, et al. Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg. 1997; 225(1):39–50.
2. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003; 6(3):345–360
3. Rhame E, DeBonet A, Simopoulos T. Ultrasonographic guidance and characterization of cryoanalgesic lesions in treating a case of refractory sural neuroma. Case Rep Anesthesiol. 2011; 2011: 691478.
4. Stamatis E, Myerson M. Treatment of recurrence of symptoms after excision of an interdigital neuroma. J Bone Joint Surg (Br). 2004; 86-B(1):48-53.
5. Sala-Blanch, X, et al. Ultrasound-guided popliteal sciatic block with a single injection at the sciatic division results in faster block onset than the classical nerve stimulator technique. Anesth Analg. 2012; 114(5):1121-1127.
6. Myers RR, Heckman HM, Powell HC. Axonal viability and the persistence of thermal hyperalgesia after partial freeze lesions of nerve. J Neurol Sci. 1996; 139(1):28-38.