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Cryosurgery for planter faciitis

Discussion in 'General Issues and Discussion Forum' started by UKA Pod, Mar 15, 2013.

  1. UKA Pod

    UKA Pod Active Member

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    Hello People,

    I'm just wondering about this procedure i've come across regarding crosurgery for planter faciitis and mortons neuroma. I'm aware that they carry out the procedure in the USA, but can we in the UK, carry out the procedure and how do we get training to do this? Basically, if anyone has any information about this, that would be much appreciated!

  2. What is the procedure?
  3. UKA Pod

    UKA Pod Active Member

  4. I don't have the time in the next few days to read the claims on the linked website but you should differentiate between cryotherapy and cryosurgery. For cryogenic neurectomy it is an invasive procedure used to ablate the nerve tissue in the same way some use it for matrixectomies. Personally I don't see any advantage - especially if Nitrous Oxide is the cryogenic as it has too slow freezing velocity to ensure adequate destruction of the target cells. Will have a read next week and get back to you..
  5. Craig Payne

    Craig Payne Moderator

  6. UKA Pod

    UKA Pod Active Member

    Many thanks.

    Do you know if podiatrists in the UK are insured to carry out this type of procedure?
  7. Depends on their competences and scope of practice.
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    I performed this procedure, when I was practicing in the UK, under the surgical umbrella. And I still have the equipment. If you are not surgically trained, I recommend you ask if your professional indemnity insurance carrier can cover that.

    Invasive cryosurgery is performed, to some extent, in the US. The treatment is not covered by any insurance carrier (to the best of my knowledge) and the patient will be required to pay out of pocket. This does happen, but it is not so common.

    About the procedure. It was recommended, first, to target the point of maximum tenderness. Later focus was directed at Baxter's nerve. Not so easy to target this little nerve 'blind'. Some claim greater success under US guidance. I am not sure it is much easier, even with this technology. If you can, then do some cadaver work to familiarize yourself well with the local anatomy. The active part of the treatment probe is very small - assuming the diagnosis is correct, success is contingent on your ability to place the probe, very accurately in contact with the nerve.

    You have to ask yourself a question: what is the prevalence of Baxter's entrapment, as a cause of plantar heel pain. Some posit that destruction of the pain receptors, from the heel, in the vicinity of the origin of the pain, can provide the anticipated pain relief. Maybe.

    The manufacturer, in some models, incorporate a nerve stimulator to assist with locating the nerve itself. Also not easy to isolate the structure. I spent a lot of time discussing the technology with the engineer.

    I have no audit figures. Drawing on anecdotal evidence, and broadly speaking, the outcome is comparable to other treatment modalities. But not as spectacular as I would want.

    In my work it was a reasonable intermediate step sitting somewhere along the continuum of conservative care and surgery - in a category that might include ECSWT and Topaz. Topaz is gaining some momentum.

    You may also want to check into prolotherapy. There is no reason why this treatment cannot be offered with a non-surgical license.

    Lastly, and I am sure I am preaching to the converted, don't forget to consider in your differential diagnosis other causes of plantar heel pain. The great majority of the common garden variety ought to respond to less invasive treatments.

    Hope this helps, some ....
  9. UKA Pod

    UKA Pod Active Member

    Thanks for the information. That's much appreciated.

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