Cryosurgery 
Cryosurgery is a specialized treatment technique to provide long-term pain relief for various foot conditions e.g. Heel Pain, Morton’s Neuroma.
People have recognized the value of cold for analgesia for thousands of years. Hippocrates left us the first written records of the use of ice for pain relief. Modern Cryosurgery as we know it today was developed in the early 1960’s. This technique is an improvement over other methods (e.g. alcohol injections, phenol applications, or surgical resection) because it is not followed by neuritis or neuralgia. Where and How Did It start? There is an anecdotal story that we owe this technology to the mother of an American Podiatrist. Plagued with a painful foot the problem persisted in spite of an attempt to excise a painful nerve with conventional open surgery. Unfortunately, the surgical experience was on this occasion such a painful one for this lady, she vowed never to have the same surgery again. Seeking alternative treatments, the Podiatrist’s boss, Dr. Fallat, searched the internet and discovered the technique of Cryosurgery, which is used regularly by other medical disciplines e.g. cardiac surgeons, cancer specialists etc. After a period of research and development, the use of Cryosurgery for podiatric-related conditions has been extensively tested, since 2003. It appears to be safe and effective. The treatment is FDA (USA) approved for use in podiatric ailments, and it is now widely used in the USA. How Does It Work? Similar to an anaesthetic, the application of cold to tissues creates a nerve conduction block. Long-term pain relief from nerve freezing occurs because the formation of an ice crystal disrupts the sensory component of the nerve structure. This can be done with equipment specifically developed for use in the foot. A nerve sensor is incorporated in the equipment to help isolate the painful area. The Procedure After numbing the area with an anaesthetic, this minimally invasive technique takes around 15 minutes to perform from start to finish. The painful area is first infiltrated with a local anaesthetic, so that the cryoprobe can be introduced without discomfort. A tiny puncture is made through the skin. Next, a small blunt instrument called a trocar is placed through the puncture site to create a portal for the cryoprobe to be introduced. The probe is inserted through the puncture site. A freeze cycle, is followed by a 30 second defrost, then another freeze. The probe is then removed. An antiseptic ointment is placed over the puncture site with a sterile dressing applied. Sutures are not necessary due to the small size of the puncture. The dressing maybe removed after 24 hours and a shower is then permitted. The puncture site is to be covered with a small amount of antiseptic ointment and a band-aid. Postoperative discomfort is minimal. It is suggested to rest over the first 48 hours. Plantar Fasciitis – Heel Pain 
Plantar fasciitis is a common ailment causing heel pain. Over the years many different treatments have been developed to try to eliminate this painful condition, with varying success. Cryosurgery is a useful addition to the toolbox of the practitioner, especially when this has a neurologic (nerve) component. Targeting the most painful spot on the heel with Cryosurgery can also provide good and lasting pain relief.
Neuromas 
Morton’s neuroma is another common podiatric condition. Symptoms present as pain commonly between the third and fourth metatarsals that causes numbness, tingling, burning, or shooting pains into the involved toes. Patients often experience the sensation of an electric shock in the ball of the foot. Pressure from ill-fitting shoes appears to exacerbate the symptoms. The term neuroma refers to a benign swelling of the nerve in the foot. Cryosurgery can be an effective option when other treatments have failed, and before making the decision to operate to have the nerve surgically removed from the foot. It has also proven effective for patients who have undergone previous surgical treatment with recurrence of the nerve tumour.
The Future As experience in this new specialist clinical area develops, the list of indications for Cryosurgery is also expanding with reports of successes in the treatment of a diverse range of conditions, such as diabetic ulcers, plantar fibromatosis and tarsal tunnel syndrome.
Mr. Dieter Fellner FCPodS
Consultant Podiatric Surgeon
www.podiatric-surgeon.co.uk
Faculty of Podiatric Surgery 28-Feb-2008
Categories: Heel pain , Common Foot Problems
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