Foot cryosurgery is a specialised treatment technique to provide long-term pain relief for various foot conditions such as Heel Pain and Morton’s Neuroma. It utilises extremely low temperatures, to shrink pathological tissue and reduce pain transmission
How Does It Work?
Cryosurgery involves freezing certain sensory nerves in the heel as well as the thickened surrounding ligament (know as the plantar fascia) next to those nerves. 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 ice crystals disrupts the sensory component of the nerve structures. A secondary benefit of the freezing process is that the thickened portions of the plantar fascia next to the nerves also shrink after the freezing process.
This treatment is performed using equipment specifically developed for use in the foot. The equipment contains a nerve sensor which is used to help isolate the targeted nerve. The treatment is also performed using real time colour Doppler ultrasound, which ensures accurate identification of the structures involved.
The nerves targeted are not destroyed but temporarily deactivated for a period of 2-3 months while the heel recovers. This allows patients to walk normally without the expectation of pain. The facilitation of normal walking promotes recovery of the plantar fascia.
It is known that people with plantar fasciitis can walk differently in an attempt to avoid pain; this is known as a compensatory gait or antalgic gait. A persisting compensatory gait can actually contribute to the problem and prevent resolution. In essence, the freezing and temporary blocking of the nerves that carry heel pain, allows a person to walk normally again, allowing the plantar fascia to heal.
The Procedure
The painful area in the heel is first infiltrated with a local anaesthetic, so that the cryoprobe can be introduced without discomfort. The probe is then guided using ultrasound imaging to the desired location.
When in place two three minute freeze cycles take place. The probe is then removed. A sterile dressing applied. Sutures are not necessary due to the small size of the puncture. The dressing should be kept in place for 36 hours and a shower is then permitted. Discomfort after treatment is minimal. It is suggested to rest over the first 48 hours.
Does cryosurgery provide a long term cure for plantar fasciitis?
Cryosurgery for plantar fasciitis has been performed since 2002 with excellent results Podiatrists in the United States report that approximately 90% of patients, after undergoing cryosurgery, had complete resolution of pain. The remainder had only minor residual pain that required no treatment.
Reference: (Dr. Lawrence Fallat DPM Chronic Plantar Fasciitis: Is Cryosurgery The Answer? Podiatry Today May 2005).
A more recent study conducted in 2009 suggests cryosurgery is an effective treatment option for chronic heel pain. The researchers evaluated 137 patients with chronic heel pain who underwent cryosurgery after failing 6 months of other standard treatments for plantar fasciitis.
The subject’s pain measurements were assessed prior to the procedure and at 3 weeks following the procedure and again at 24 months. Seventy-seven percent of patients reported successful pain relief at both 3 weeks and 2 years. The authors concluded that cryosurgery was successful in both the short term and long treatment of chronic heel pain.
Reference: Cavazos GJ et al. Cryosurgery for the treatment of heel pain. Foot Ankle Int. 2009 Jun; 30 (6):500-5.
If patients are unlucky enough to experience a return of symptoms at the one or two year point the procedure can simply be repeated.
Are there any complications associated with Cryosurgery?
There is a very low incidence of complications associated with cryosurgery. Infections and abscess formation are rare. Such complications are typically dealt with using oral antibiotic therapy. Loss of sensation is confined a small area under the heel, the numbness typically lasts 3-4 months.
Can anyone have cryosurgery?
Obviously cryosurgery involves very cold temperatures, therefore this procedure is not offered to those patients with poor circulation or peripheral vascular disease or conditions such as chilblains or Raynaud’s Phenomena or poorly controlled diabetes.
Costs
The costs of ongoing training, running and maintaining cryo injection therapy equipment is high and provides little cost savings over conventional Plantar Fasciitis surgery.
Is there a waiting list?
We are the only centre in the UK offering cryosurgery for treatment of plantar fasciitis and the current waiting list is 2-3 weeks. If you are travelling from a long distance we can offer advice on airport transfers from Manchester or Doncaster airports and provide information regarding the Kenwood Hall Hotel, which is 2 minutes away from the clinic and provides clinic patients with a discount.
