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Have a date for cryosurgery

Posted by Curt on 8/26/04 at 13:52 (158736)

I posted back in July about cryosurgery with Dr. Fallat. I had my appointment with him last week and am set for the procedure on October 9. He only does them on Saturdays so he can train other doctors on the procedure.

He said that over 2 1/2 years he has had a 90% success rate. The pain is either gone completely or is lessened considerably, like a 1 or 2 rate on a pain scale of 1-10. The cooling is done with nitrous oxide through a probe. It destroys the nerve cell by freezing intracellular elements leading to cell death. But the soft tissue surrounding the nerve remains intact so the nerves grow back. He said that they have found though that the pain doesn't come back when the nerves grow back. The other benefit of the cooling is it drastically reduces the inflammation. Before the procedure they want to find the specific area where the pain is the worse (in my case, the front of my heels) and then treat that area about the size of a quarter. Takes about 6 minutes and just a small puncture wound, no stitches. Then you are to take it easy on the treated foot for a couple of days.

They're just doing my right foot first and if it works, I'll have the left done later. I asked about talking to some pts. that had the procedure done but the woman I talked to in the office said they couldn't give out that info because of privacy laws. Besides the usually risk of infection with any procedure it sounds like there are no negatives besides it may not work. Nothing else seems to help me at all. I have been trying ART with no success besides the usually orthotics, night splints, shots, etc, etc. so I'm going to give this a try. I'll let everyone know how it turns out in October.

Re: Have a date for cryosurgery

Dr. Z on 8/26/04 at 15:16 (158742)

Curt,

I wish you luck. There is one thing I don't understand with this specific technique. If there isn't a nerve involvement why are they treating the plantar fascia. My understanding and from my research and studying with the founder of this procedure it is only done for pf when there is a specific nerve involvement. There is no reason why you can't speak with a patient that has had this done if the patient is willing. We do it all the time. We first ask the patient permission then have the you call the patient.

Re: Have a date for cryosurgery

Curt on 8/26/04 at 18:28 (158758)

Dr. Z,

If the pain from plantar fasciitis is caused by microscopic tears where the fascia attaches to the heel, isn't the pain that you feel conducted by the nerves in that area? So if you deaden those specific sensory nerves wouldn't you relieve the pain from the microscopic tears? I agree with you as far as having them contact the patient and having the patient then contact me. The lady in the office just wasn't very cooperative and I am going to try again. Every office seems to have one difficult employee!

Re: Have a date for cryosurgery

Dr. Z on 8/26/04 at 21:12 (158764)

Curt,
The problem with this logic is that the pf is still damaged and could rupture if there is no nerve reception . Dr. Trecott who invented the cryotherapy approach was questioned by Dr. Z about this pf approach . She only uses cryotherapy for pf that is caused by nerve problems ie medial calcaneal nerve and never treats the pf directly. I ask her why and told me makes no sense . Cryotherapy is only approved for the treatment of nerve not tendons, fascia.

Re: Have a date for cryosurgery

Curt on 8/27/04 at 07:09 (158781)

Dr. Z,

I will talk to Dr. Fallat about what you are saying and see what he has to say. Thanks for your comments. I definitely want to hear all sides before I get this done.

Re: Have a date for cryosurgery

Dr. Z on 8/27/04 at 08:27 (158788)

Call Dr. Tescott in Jacksonville Florida she is the expert in this area if you want a second opinion.

Re: Have a date for cryosurgery

john h on 8/27/04 at 10:16 (158796)

You can deaden the pain from most anything with a nerve block. If one were to permently block signals from the nerve any muscle involved with that nerve would deteriorate to the point it would be usless. for example it is not uncommom for a person to have permenent Drop Foot because of untreated nerve pressure problems on a nerve exiting the spine. Some nerves can do regenerate. Some do not.

Re: Have a date for cryosurgery

john h on 8/27/04 at 10:30 (158798)

I would think anytime you freeze a nerve to the point it may die there is a hughe risk depending on what muscles,tendons,etc this nerve serves. Some of the more serious things that can go wrong with any surgery is nerve damage. Some nerves do grow back to function but others once dead are dead for ever

Re: Have a date for cryosurgery

Cyndi on 8/27/04 at 11:30 (158804)

I can speak from experience. I had this procedure done in June 2004.
I had no morning heel pain so am atipecal, if in fact I even have PF.
I also had the nerve test before this procedure and all showed ok, But everything showed ok, so, I thought, Ok, try this. I could not talk with anyone either but my Dr told me he did about 50 with only three not working and just no improvement. So now make that four! I sincerely hope this alleviates your pain, it just did not for me. I had brusing for about a week, so I suggest you do stay off this foot as much as you can.
I also would suggest a couple of stress balls or something to hold. It is not like the injections for inflammation but no pain Rx really needed for the procedure. I did take Rx for infection, put a band-aid and neosporin on the site for about a week till I saw the DR again. It healed nicely but the site is still very sore when I put on a shoe. I see where if it treats the nerve to the planter, it should relieve the pain is why I had this done. It just did not help me any! Good luck!

Re: Beware of 90% success rates

Darlene on 8/27/04 at 12:04 (158808)

Curt:

I would recommend that you ask specifically how many procedures were done for your exact problem and what were the results. I read that the cryosurgery was done mainly for morton's neuroma. Also, instead of just giving you the overall 90% success rates, ask to see the research and results for your specific issue. If they are not receptive to these kinds of questions, I would be very careful.

Re: Have a date for cryosurgery

Dr. Z on 8/27/04 at 14:06 (158812)

Did they treat the medial calcaneal nerve or the pain spot on the plantar fascia?

Re: Have a date for cryosurgery

Curt on 8/27/04 at 16:17 (158816)

Dr. Fallat wasn't in today so I emailed Dr. Goldstein who does this procedure for pf. He said Dr. Trescott works for a cryosurgical company called Wallach. He said their machine is not FDA approved for pf while the Cryostar machine he uses is. He states that she only believes in its use for nerve problems as she is a pain management doctor. He says he has had over 700 procedures for pf within the past 2 years with an overall success rate of 93%. He does this procedure on a weekly basis for pf with excellent results.

I asked about rupturing the pf because of nerve deadening and he said there is no harm or chance of tearing the pf. This can happen from repeated cortisone injections. If you get any numbness it is the size of a dime so you do have entire feeling.

Dr. Fallat did state when I saw him that when it comes to using this procedure for pf, it may take more than one treatment. Before the procedure they try to isolate a specific area where the pain is the most intense and treat there. So some pts. come back stating the pain is gone in one area but they still feel it in another so they treat that area. It didn't sound like they are poking you all over but some pts. do need more than one treatment. Possibly this is why it didn't work for Cyndi, maybe it missed the correct area for best pain relief.

As far as nerve damage where you can have muscle nonfunction, you are talking about motor nerves not small sensory nerves in a very small area on the bottom of your foot.

We all know that different things help different people, otherwise I wouldn't be considering this. I would be 'cured' from my orthotics by now. If that many procedures are being done and they are helping even 50% of the pts., I would still consider it as an option as there are few out there with any better odds.

Re: Have a date for cryosurgery

Dr. Z on 8/27/04 at 17:10 (158827)

Hi
It is possible that cryotherapy can help you. Neither machine has FDA approval specically for pf and 700 cases well that is alot of cases for using a machine for about six months. Again Cryotherapy could help but your information is very strange.

Re: Have a date for cryosurgery

Curt on 8/27/04 at 17:33 (158832)

Dr. Z,

Why do you say 6 months? It was 700 cases over 2 years according to Dr. Goldstein.

Re: Have a date for cryosurgery

Curt on 8/27/04 at 18:10 (158834)

I found this site http://www.footcryo.com/definition_cryosurgery.html
that states about the Cryostar being FDA approved for podiatric ailments in June of 2003. Maybe that is what Dr. Goldstein meant, not just specifically for pf.

Re: Have a date for cryosurgery

Darlene on 8/27/04 at 19:12 (158836)

When I spoke with Dr. Goldstein he had done about 30, and I believe mostly for neuromas.

Re: Have a date for cryosurgery

Dr. Z on 8/27/04 at 20:53 (158840)

That is how long Dr. Goldstein has been using the cyrostar. Maybe he was quoting a study not his personal work.

Re: Have a date for cryosurgery

Curt on 8/28/04 at 07:18 (158848)

Yes, I believe that is right. When I read the email again it says over 700 procedures have been done with a success rate of 93%. I guess I misinterpreted that to mean he had done that many. Then he said he does this procedure on a weekly basis with excellent results for pf.

Re: Have a date for cryosurgery

Dr. Z on 8/28/04 at 08:14 (158851)

Ask for the literature that states that 700 procedures were done over a two year period. I believe that this is non-published and is from a lecture by Dr. Fallet. As per the FDA approval for Pf check that again. I do know that the cryostar is a FDA approved device which is a must for distribution but it does not have specific FDA approval for PF.
The problem I see with this procedure is that it never addresses plantar fasciosis which is the chronic non healng degenerative area that needs to heal. Stopping pain is an excellent idea howver you need to address the fasiosis

Re: Have a date for cryosurgery

Cyndi on 8/28/04 at 08:26 (158853)

Possibly this is why it didn't work for Cyndi, maybe it missed the correct area for best pain relief.

That could be very true! My pain is in the whole arch area of both feet, not the heel area.
You mentioned Dr Fallet, Is he Dr.Lawrence Fallet in Fl. My Dr gave me a CD to view about the procedure. Ask you DR for one. IT shows both procedures for Morton's Neuroma and PF.
Also My DR did use the Cryostar machine in the above link.

Re: Have a date for cryosurgery

Curt on 8/28/04 at 08:55 (158857)

Yes, it is Lawrence Fallat. He is in Taylor, MI. I'm in Imlay City, MI about 1 1/4 hours away so it worked out good for me.

Dr. Z,

I agree fixing the problem not 'covering it up' is always the best solution. However, as nothing else it working and it's been 2 years now, I don't really care. If I can't hurt my feet anymore with this procedure and it gives me pain relief for a significant amount of time, I'll take it. I believe most people who are in constant pain would agree.

Re: Have a date for cryosurgery

Dr. Z on 8/28/04 at 09:25 (158858)

Curt,

I agree with you 100%. Just was trying to point out all I know about this procedure. If you could get any relief of pain without any major complications that is the way to go.
When this procedure first came out I did some nerve only ie neuroma procedures with the machine.. The nice thing about this procedure is it is simple, quick and very patient friendly to perform. As for the results this debate will take some time.
I refer to Dr. Goldstein for patients that I think will benefit from Cryotherapy. I think you are probaby one of those.

Re: Have a date for cryosurgery

Curt on 8/28/04 at 09:57 (158861)

I appreciate you taking the time to help out on this board and offering your experience and opinions. I hope it helps. Before I used to backpack for miles, now I would be happy to walk with my wife and kids in the mall without being in misery! I'll keep everyone posted on my results after Oct. 9.

Re: Have a date for cryosurgery

Pauline on 8/28/04 at 12:45 (158867)

With result so good why don't we hear more about this option for neuroma patients that post instead of those painful alcohol injections or neruoma surgery?

Re: Have a date for cryosurgery

Dr. Z on 8/28/04 at 13:54 (158872)

He is talking about pf treatments Neuroma surgery with cyrotherapy was discussed sometime back. I posted the results. 39% painfree I believe were the results in about 50 cases. The alcohol injection aren't that painful I give them alot. It is the technique that makes them painful.

Re: Beware of 90% success rates

Dr. Z on 8/28/04 at 14:49 (158874)

Darlene,

I gave the results for pain free cryotherapy for neuroma. It was 39% with 83% satisfaction rate. I believe satisfied meant decrease pain level of at least 50%

Re: Beware of 90% success rates

Ed Davis, DPM on 9/01/04 at 15:48 (159108)

I am still puzzled as to why there are so many trying to 'reinvent the wheel' when it comes to neuroma surgery. I could understand the need for doing so in plantar fascial release surgery. I would place my satisfaction rate with neuroma surgery at close to 98%. I just cannot see a reason to change to do something different. It is a simple procedure, with a few caveats but works almost all the time. My best guess is that if one is expereincing a lower satisfaction rate, then the real reason could be a flawed diagnosis. There just is not that much to the procedure.
Sometimes a mixed diagnosis exists, eg. plantarflexed metatarals (dropped) plus neuroma and need an orthotic afterwards or concomittant metatarsal elevation. Also, multiple interspace neuroma like pain can be due to early tarsal tunnel syndrome.

As far as 'being aware,' there are times to do so but there are things that almost always work, like getting rid of an ingrown toenail -- we can easily and honestly say 98% plus. I find a similar situation with Morton's neuroma. I would be aware of the 'new' techniques for neuroma surgery that propose a 'better' solution than the tried and proven techniques.
Ed

Re: Dr. Ed

Darlene on 9/01/04 at 22:11 (159128)

Please help me to understand how you would systematically analyze what is going on in the foot to figure out where the pain is coming from and what the best course of action is.

I have:
1) a confirmed morton's neuroma in the 3rd webspace
2) similar pain in the 2nd webspace with something showing there in the MRI
3) tts type symptoms. pain just inside the ankle going down to the medial side of the arch. It's tender when I press on this area of my arch. The pain also goes up the medial side of my leg a little bit
4) dropped 4th met head

When an anasthetic was injected into the 3rd webspace (and I believe some migrated to the 2nd webspace) all of the neuroma type pain was gone.

Thank you for your thoughts.

Darlene

The tts symptoms began in June due to my altered gait. I have custom orthotics but I think I'm still pronating a little in them.

Re: Have a date for cryosurgery

Jan B on 3/20/05 at 10:39 (171619)

Hi Curt,

todays date: March 20, 2005

I recently watched a news segment on TV about this proceedure. My boyfriend suffers tremendously with shoots of pain in his heel. Please let me know how your cryosurgery went, pros and con!! Many thanks in advance, Jan