Cryosurgery

What is Cryosurgery?

 

Cryosurgery involves the use of extremely low temperature nitrous oxide or liquid nitrogen controlled with a handheld probe to destroy pathological tissue. Cryosurgery has been used for decades to treat a wide range of medical conditions such as malignant tumours, and various dermatological conditions such as warts. It has also been used for pain management in patients that suffer chronic pain including chronic plantar heel pain.

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The Procedure

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The procedure is minimally invasive and is performed under local anaesthetic to numb the local area of where the cryosurgery probe is introduced. The procedure should be performed under ultrasound guidance or with a nerve stimulator so that the clinician can correctly identify the exact location of where the administer the freeze cycle.  The area of damage is approximately 3.5 by 2.5 cm in diameter.

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After the Procedure

 

As the procedure is minimally invasive, recovery is relatively fast. Following the procedure a light dressing is applied. You can return to weightbearing in regular footwear such as a trainer. It is advised to minimise your activity levels for the first 48 hours after the procedure and to take a short course of basic pain medication to minimise post-op discomfort such as paracetamol and ibuprofen.

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Does it Work?

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Ther are only a couple of published clinical studies reporting on the success rate of cryosurgery for plantar heel pain and the quality of the research is low as both these studies were case reviews with no comparison treatment or placebo group. Nonetheless, both studies demonstrated high success rates with cryosurgery for treating chronic plantar heel pain.

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My Verdict

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There is currently a lack of evidence to support the use of cryosurgery to treat plantar heel pain, however the aim of cryosurgery is similar to radiofrequency nerve ablation in that the clinician is targeting the sensory nerves in the heel which transmit pain signals. The difference between the two is that cryosurgery uses extreme cold temperature to destory the nerves whereas radiofrequency uses heat temperature to destroy the nerves. The thinking behind cryosurgery does make sense and the procedure does appear to be generally safe with low complications reported, however the size of the area exposed to freezing is quite large which may damage local healthy tissues around the nerve, resulting in harmful effects in the long term, however there is currently no evidence to confirm or refute this. Overall, I think cryosurgery is a potential option worth considering in some cases, providing the patient has previously tried a wide range of other evidence based treatment options and is fully aware of the potential limitations and risks for cryosurgery.

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I currently do not offer this treatment option but if you are interested in this treatment get in touch and I will advise on a recognised provider in your local area.

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